Great article. For your research you can also look into a few other issues
1 - not all docs bill the same. This lack of billing knowledge means docs doing the same exact thing can make vastly different amounts, especially if you extrapolate that over their career
2 - further down the chain of care you have PBM which are like the mafia and get to decided to get what’s drugs and what cost, behind closed doors
3 - docs know that insurance will counter so they give a higher bill (claim), especially with Medicare/medicade, which results in a messy process which is often not profitable for hospitals
4 - the burden of pressure on docs having to change their treatment pattern to follow insurance rules so they get reimbursed. Aka, why the hell does insurance get to decide the treatment algorithm.
Overall, great work with this one, excited to continue reading.
Hey! This is a great article explaining RCM in the medical industry. I like how you split RCM into 3 parts and listed the short-term tech solutions and long-term medical-focused solutions for RCM issues. One thing that would make it better would be to add a pie chart when explaining contractural allowance. It would make it easier to visualize. Overall, its a good article👍
Great article. For your research you can also look into a few other issues
1 - not all docs bill the same. This lack of billing knowledge means docs doing the same exact thing can make vastly different amounts, especially if you extrapolate that over their career
2 - further down the chain of care you have PBM which are like the mafia and get to decided to get what’s drugs and what cost, behind closed doors
3 - docs know that insurance will counter so they give a higher bill (claim), especially with Medicare/medicade, which results in a messy process which is often not profitable for hospitals
4 - the burden of pressure on docs having to change their treatment pattern to follow insurance rules so they get reimbursed. Aka, why the hell does insurance get to decide the treatment algorithm.
Overall, great work with this one, excited to continue reading.
PBM Mafia post is incoming 🫡
Hey! This is a great article explaining RCM in the medical industry. I like how you split RCM into 3 parts and listed the short-term tech solutions and long-term medical-focused solutions for RCM issues. One thing that would make it better would be to add a pie chart when explaining contractural allowance. It would make it easier to visualize. Overall, its a good article👍