Insurance codes, computers, & "cookbook" chiropractic
Article Abstract:
The insurance industry is currently focused on controlling the rising costs of health care. However, inaccurate coding of claims resulted in a $5.8 billion loss to insurers and employers in 1989. In that year, estimated total health-care expenditures exceeded $599 billion, including $119 billion for physician services. Costs increased by 9.1 percent for hospitals and 13 percent for physicians. One of the most costly categories of health care expenditures was physician care. Physician charges are predicted to increase further, although incomes of physicians and chiropractors have not changed accordingly, because of increased competition for patients, pressure to enroll in discounted fee programs, and rising overhead. The overall inflation rate increased 4.4 percent in 1988 but physicians' incomes increased only 1.2 percent. Some physicians and chiropractors have subsequently become more aggressive in their billing practices. Codes for physician and chiropractic services have been established to standardize services. Three common types of coding errors are described and include: (1) coding of procedure combinations that are clinically unlikely; (2) charging for a procedure more extensive or intensive than actually performed; and (3) charging separately for procedures that can be included in a single procedure. In the future, computer software will be developed to define, detect, and correct coding errors. However, chiropractors should be aware of the insurance crisis, and help to contain rising health care costs. Health care professionals, including chiropractors, should aim to provide care that is appropriate for a particular diagnosis, and to accurately report their costs to insurance company. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Chiropractic
Subject: Health
ISSN: 0744-9984
Year: 1991
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Chiropractic care: a view from the business perspective
Article Abstract:
Chiropractic care can help to improve motivation and productivity of workers, and chiropractors should participate in productivity improvement within the business community. For example, faulty design of work settings and work procedures can contribute to the development of back and/or neck injuries, which can be managed by chiropractic care. However, the business community, insurance companies, and third-party payors have been slow in accepting the value of chiropractic care. Health care costs have increased 21.6 percent since 1989 and by 46.3 percent sine 1988, and new methods of containing costs, such as managed care, have been developed. Managed care is a health-care delivery system in which the health professional, employer, employee, and insurer work together to improve the quality, efficiency, and cost-effectiveness of health-care resources. However, the chiropractic is often excluded from managed-care systems, or chiropractic services within this framework tend to be restricted. One study showed that chiropractic care of work-related back injuries reduced insurance claims to a greater extent than care provided by medical doctors for similar injuries. Chiropractic management can be less costly than medical procedures such as surgery in correcting certain injuries. Hence, third-party payors should assume the responsibility to ensure that their health care providers deliver high-quality and cost-effective care. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Chiropractic
Subject: Health
ISSN: 0744-9984
Year: 1991
User Contributions:
Comment about this article or add new information about this topic:
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