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1 minute
Thanks for posting on the little-known (but profound) effects of up-coding on the medical spend.
We could have the most pristine Medicare-for-all program that still did not save us a nickel– because providers would find the highly-paid niches in the schedule.
You imply that insurers should fight back against upcoding, and are fools if they don’t.
Fighting each individual upcoded claim would be very costly in time and staff…simpler to just pay the larger claims, and go back to the employer with higher premiums.
George Halvorson (ex-head of Kaiser) was in charge of claims at a Midwest insurer in earlier years. He once went to a hospital CEO and asked him why claim payments kept going up. The CEO said, “We can outsmart any new fee schedule in a few weeks. For a really tough fee schedule, it takes maybe 6 months.”