Single Payer Healthcare - Effect on Medical Industry

[XenaLives]

Here's how Medicare Advantage companies wring out extra profits, it's all about the money:

Health insurers have perfected a way to wring billions more in revenue from the Medicare program by combing patient medical charts for additional diagnosis codes to submit to the federal government for payment.

The latest example of the massive returns that insurers reap from the practice known as a retrospective chart review was outlined in legal documents filed in a case against Indianapolis-based health insurer Anthem. The documents show Anthem pocketed more than $112 million in additional Medicare Advantage risk-adjustment payments in 2015 and $102 million in 2014 while spending little over $18 million each year to carry out the review program.

Identifying and documenting additional diagnosis codes to send to the CMS for risk-adjustment payment is perfectly legal if the patient's medical record supports it. In fact, the way Medicare pays Advantage organizations encourages them to code all diagnoses possible. Traditional Medicare providers do not have that incentive.

https://www.modernhealthcare.com/article/20180901/NEWS/180839977/insurers-profit-from-medicare-advantage-s-incentive-to-add-coding-that-boosts-reimbursement

This is why I get up to six marketing calls per day for insurance:

The Affordable Care Act calls for significant cuts in reimbursements to insurers providing Medicare Advantage (MA) coverage, which has been the most popular alternative to traditional fee-for-service Medicare. Opponents of these cuts argue that they carry serious negative repercussions for seniors, and have lobbied successfully to force their postponement. But research suggests that cuts to MA reimbursements actually are unlikely to harm consumer welfare. The research indicates that higher MA reimbursements do not translate into less expensive or higher quality care for consumers. But they do benefit insurance firms, which see higher profits, some of which they channel into increased advertising to encourage more people to enroll in the MA plans they offer. While lower reimbursements likely would reduce insurance firm profitability, they would substantially improve the federal budget—without negatively impacting the quality of care received by patients.

https://publicpolicy.wharton.upenn.edu/issue-brief/v2n5.php