Managed Care  Current Billing System Fosters Error, Dishonesty
MANAGED CARE March 2005. © MediMedia USA  Current Billing System
Fosters Error, Dishonesty  Michael S. Victoroff, MD MANAGED CARE
March 2005. ©MediMedia USA   Michael S. Victoroff, MD  The U.S.
medical claims payment system was designed by Kafka and
implemented by Monty Python. Its inefficiency and high error
rate are exacerbated by a disappointing volume of straight up
fraud.  Who has not become exasperated trying to match what was
submitted to his insurance carrier with the services he received
from a "pay-for-CPT" provider? Why is this so hard? Because the
claims system is corrupt! I use that word in its broad sense,
encompassing both inadvertent message garbling as well as
deliberate acts of dishonesty. Behold, an example.A few months
ago, I lacerated a finger in one of those western states where
they have lots of horizon. After trying folk remedies (mainly
shouting special words), I surrendered to a local ED for a
stitch and a tetanus shot.