Hello. Dr. Keith Smith with you – Surgery Center of Oklahoma. Thank you for joining us in this video blog series.
Let’s talk about a couple together. One is ICD-9/ICD-10. These are coding regulations and these complicated numbers physicians are required to attach to billing forms in order to receive payment. These codes are the product of the American Medical Association, which has a very lucrative contract with the Federal government to produce these codebooks. They actually have a monopoly contract to produce these codebooks.
And without these codes, basically physicians who are submitting insurance claims to Medicare of Medicaid have to have these codes on these forms, or they’re not going to be paid.
The vast majority of the AMA’s revenue comes from this contract. I, frankly, don’t even know a doctor who belongs to the AMA – I certainly don’t. I know that comes as a shock to many of you.
These codes have become so complicated with the latest addition – ICD-10 – that I personally know physicians who have sold their practices to hospitals because they do not believe, in private practice, they can comply with the new codes.
I’m not exaggerating when I say there are codes for ‘injured while waterskiing by a turkey.’ This was reviewed on John Stossel’s episode where he reviewed this coding insanity. And there are countless others that are just as absurd.
Of course, not only do you not get paid if you mess up on these codes, but physicians actually run the risk of being accused of fraud if the wrong codes are used. And then they get to exercise the privilege of going completely bankrupt defending themselves from these allegations.
ICD-10 is something that is driving a lot of physicians out of private practice into the “welcoming arms” of the hospitals who would love to employ them.
Along with this scam, is also disparate payments, where, for the very same codes, physicians who are employed by hospitals for performing one service are paid vastly more than a private physician performing the very same procedure or service.
These are two scams about which I would not imagine most of you are aware. But the ICD-9 with the conversion to ICD-10 is a disaster. And the disparate payments, where physician services billed under a hospital code are paid vastly more than the same physicians services by a private practitioner.
You’d think that Medicare, in order to balance its budget better, would seek out physicians that are not hospital employees. But that is not the case at all.
Thank you for joining us in this series. We will see you next time.