I have explained before how providers submit claims with various codes on them for reimbursement by payers. What the codes “say” often determines how much the provider gets paid. Here is another example of how changing coding changes provider behavior. You may want to believe that providers aren’t influenced by their economic interest, but you would be dead wrong. They are human beings and increasingly they work for large health systems that encourage and incent them to maximize reimbursement through coding. In this case, reimbursement for abdominal wall hernia repairs was tied to the size of the hernia. After that change was made, miraculously surgeons started finding more large hernias that got higher reimbursement. So again, don’t imagine are some innocent victims of the payer system, they are part of the problem of higher costs. (JAMA Article)
Well well well, who couldn’t have seen THAT coming! There’s never enough money paid out, is there! Money is so corrupt, or rather, misused, or then again, it’s not money, it’s those that want it.