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Uncompensated Care

About 23% of claims are paid at a rate of zero…for a number of reasons, but that means that the physician practice has to sort out those reasons, resubmit those claims, find out why they were denied; and if we had a fair and transparent process, we wouldn’t have to be spending health care resources tracking payments that are owed to the physicians who perform the services.

Barbara McAneny, M.D.

American Medical Associations Board of Trustees,

Can you imagine any other business wherein 20%-30% of the time is spent on non-value added administrative work, tracking and reimbursing payments owed them?

Profit through Incompetence

The hardest part of starting a medical practice is learning how to deal effectively with the insurance companies. Compared to them, medicine is easy… Insurance companies have managed to develop an almost perfect system of “profit through incompetence”. If you make a mistake, they don’t pay. If they make a mistake, they don’t pay. So my receptionist usually spends hours on the phone to insurance companies tracking payments or following up on denials: Start with a voice menu, be put on hold, transferred, put on hold again, cut off, repeat. On a (very) good day she’ll finally get the right person and be told “after re-examination, it appears that you’ve done everything correctly and the check should be arriving soon” click, buzz…”- David Belk MD.

Prior to leaving medicare, we were spending an enormous amount of time fighting incompetence when we should have been focusing on providing an outstanding patient experience!

With the recent passage of the Patient Protection and Affordable Care Act (what some have disparagingly referred to as “Obamacare”), it is clear that administrative demands and uncompensated care are only going to get more oppressive. In order to continue to practice medicine within the system I would have been forced to make compromises: in quality of care, in technology, and in service. These are not compromises I am willing to make.

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