2016 Postmortem
In reply to the discussion: Avg health care spend is $6,125 (working age) and $3,628 (child) but Bernie claims you only pay $466 [View all]R.A. Ganoush
(97 posts)regarding your post. You posture that if SP is enacted, that medical facilities would be able to reduce office headcount by up to 2/3 because of the lack of claims processing through insurance companies.
Have you ever asked a physician who accepts Medicaid or Medicare if claims processing is easier with CMS vs. processing through insurance companies?
From my experience (my wife is a doctor who operates a cash-only practice and no longer accepts Medicare patients, so I've heard the complaints more times than I can count), CMS is a much larger challenge to get claims approved than the carriers, and involves multiple submissions in order to get approval (e.g. if printed data in fields isn't properly aligned, and extends outside of the designated box by even a hair, the claim is rejected and must be resubmitted). Granted, it is not the case in every instance, but I don't think its as seamless as you make it out to be if we cut out the insurance carriers. (I'm truly curious if there is any data available that shows the average amount or number of submissions prior to getting a claim approved through each).
The reason that many practitioners will not accept Medicare and Medicaid patients isn't necessarily the lower reimbursement rates than carriers, but the extra red tape from CMS that requires repeat efforts to get approval and negates any increase in office efficiency.
If we want to make a move to SP or Medicare for all, those logistical problems are going to have to be improved in order to get the medical practitioners on board. Otherwise, I think you will see larger amounts of physicians who will move to cash only, in addition to a doctor shortage.