Economics 10?

[Marty]

I self test with a Coaguchek but once a year at the time of my annual physical I get a prothrombin time along with other tests from the central lab just to see if my Coaguchek is in the ballpark. this year both INR's checked out at 3.2, unusual but reassuring. I asked my PCP why he didn't get a Coaguchek and do them in his office. He said he would like to but would not get paid by any of the plans in this area. Recently I got my notice from Medicare about how my claim was paid. The amount charged for the prothrombin time was $25.00. Medicare approved $5.25! and noted that this service was paid at 100% of the Medicare approved amount and I could not be billed any extra.Perhaps Al, or someone else could enlighten me about how the economics of prothrombin testing works. What do non-Medicare patients pay? How much does your insurance pickup? How much do you pay if your doctor tests in his office? If they don't pay a reasonable amount, lab testing for prothrombin may go the way of the flu shot!

 

[Guest]

All health plan payments are smoke, mirrors and hocus-pocus. My eye doctor billed something like $585.00 and got paid about $125.00 for my last visit. In my case, my salary is reported to Medicare on the hospital's cost report. This precludes me from billing anything to medicare for my services. We only are able to bill as a lab test for which we get the aforementioned $5.25. However, if I understand it correctly hospitals never know what they really get pain by Medicaid. I think they make an electronic payment to the hospital's bank account and then notify the hospital that the payment was for patient X, Y anz Z. But they do not tell how much they paid on any person's actual bill. I'm probably not exactly correct but I think what I wrote makes about as much sense as the actual procedure Medicare uses.

A Medicare official told a meeting that I attended once that the biggest mistake people make in dealing with Medicare is to assume that it is a rational system. It is not, never was and is not intended to be. It is a collection of laws saying what they must do, some saying what they must not do, and some saying what they could do. These laws were largely passed at 2 AM on the last day that Congress was in session when two legislators agreed by saying, "OK I'll vote for the project in your district is you will vote for my Medicare bill."