cool

A blog called Big Government has this post up – AMA Endorses Largest Denier of Health Care Claims – as smoking gun proof that Medicare is a heartless government institution because a report card(pdf) by the AMA on health insurance providers shows Medicare rejects a larger percentage of claims then the nation’s largest corporate insurers (6.85%, with private insurer Aetna a close second at 6.8%) . The report only shows that Medicare – with by far the largest number of claims – rejects some. The same report also notes Medicare with Payment Timeliness – 99.99% and Accuracy of payments – 98.53%. Only one private insurance company scored higher on accuracy. In a less then ideal chart of why claims are denied, the report says Medicare rejects claims frequently for wrong billing codes, being billed for non-covered services. Out of a total of 675 remark codes ( reasons payment was not made on a claim or part of a claim) Medicare used the highest at 95. That would suggest that many providers are not using proper billing codes for Medicare claims – which ties into this story from a recent post – Less than half of medical students understand health care system. I’ve read the AMA report card several times for any proof or indication that Medicare’s motives could be unequivocally attributed to spite, maliciousness or indifference and the report simply does not supply that information. That information being completely absent from the report card, Big Government and quite a few anti-health care reform comrades, have filled in that gap by assigning their own biases. Some other possible reasons for the number of denials could be that the bulk of Medicare recipients are a high risk group – those 65 or older. That group also gets the highest number of high cost medical procedures and surgeries. The more complex the claim the more likelihood of having questions about billing. One myth this report card dispels, probably to the disappointment of yellow faux journalists at B.G., is the idea that government agencies are careless fountains of wealth who cut checks without careful adherence to the rules and regulations regarding disbursement of funds.

In addition private insurance companies do two things Medicare cannot do. One, private insurers can get a mix of high, low and moderate risks policy holders. Statistically speaking all of Medicare recipients are high risks. The more visits to the doctor, the more claims. Second, private insurers can simply cancel a policy because they do not want to pay a claim. An event that would not be counted in the claims denial column. There is a third possibility. The AMA has recently been tilting toward supporting President Obama and Democrats plans for health care reform, but the AMA has a history of knee jerk opposition to any health-care reform. So it is possible their methodology and their calculations are way off, especially considering a report by the California Nurses Association/National Nurses Organizing Committee

Claims denial rates by leading California insurers, first six months of 2009: • PacifiCare — 39.6 percent

• Cigna — 32.7 percent

• HealthNet — 30 percent

• Kaiser Permanente — 28.3 percent

• Blue Cross — 27.9 percent

• Aetna — 6.4 percent

A few of those companies are not on the AMA report. Aetna’s stays about the same. Cigna’s percent of denials goes up about 29% on the California Nurses Association/National Nurses Organizing Committee report. HealthNet goes up about 26%.

warm

Vaccine for cocaine habit? May be coming soon

A simple shot could be the latest tool in curbing cocaine abusers’ habits, says new research. The vaccine-like shot not only kept them from getting high but also helped them fight their addiction, showed the first successful rigorous study of this approach to treating illicit drug use. The shots didn’t work perfectly, but the researchers say their limited success is promising enough to suggest the intriguing vaccine approach could be widely used to treat addiction within several years. “It is such an important study. It clearly demonstrates … that it is possible to generate vaccine that could interfere with cocaine actions in the brain,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which funded the study. The results come just days after that government agency announced plans for the first late-stage study of an experimental nicotine vaccine designed to help people quit smoking. The NicVAX vaccine has been fast-tracked by the Food and Drug Administration, and the research will be paid for with federal stimulus money. The cocaine and nicotine vaccines both use the same approach, stimulating the immune system to produce antibodies that attach to molecules of the drugs and block them from reaching the brain.

Soon we’ll have to think up some new ways to generate the angst ridden journeys of self-discovery in novels, songs and movies. Memory enhancing drugs are bound to have some dark graphic novel inspiring drawbacks. Then there is the monotony of possibly living three or four hundred years.

I know some people with shopping addictions and/or addictions to accumulating stuff. Hopefully some wonder drug is in the works for them too.