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A petabyte of health insurance prices per month

blog.turquoise.health

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Re: A petabyte of health insurance prices per month

#81

Post by willcipriano »

natosaichek wrote: post #61
valleyer wrote: post #52

Earlier quoted context omitted.

Because, like it or not, a doctor's discretion can sometimes be self-serving. The more treatments a doctor gives, the more they get paid, and there is an enormous information imbalance between doctor and patient. (As in, they went to medical school, and you didn't.) Unfortunately, some doctors are willing to take advantage of this.

It's kinda ridiculous that because it costs x billion in doctors overcharging, we'll spend 100x on administration to control costs. Cutting off one's nose to spite one's face and all that.

Nobody actually wants to control costs. From doctors to hospitals to insurance companies, everyone but consumers benefit from high prices.

Re: A petabyte of health insurance prices per month

#82

Post by redandblack »

FireBeyond wrote: post #60

I used to work for a company that writes claims benefit management software. This: > Notice how every item has a price that requires external information to understand: > Per diem rates are paid for each day a patient is in the hospital. We need to know how long the patient will be in the hospital to know the total amount. > Rates for Cardiac Studies require knowing the price the hospital will bill in the future. The…

Will LLMs eventually help with this - will be great if it can create structured data out of this to learn/classify

Re: A petabyte of health insurance prices per month

#83

Post by baishtar »

marcus0x62 wrote: post #48
chimeracoder wrote: post #31

Earlier quoted context omitted.

Those are ICD codes, which are not the same as billing codes. ICD represent diagnoses , not services rendered. ICD codes also are somewhat procedural in their generation - that is, there's a whole grammar to how they're formed. For example, you'll have something like "contact with", then a whole number of different animals, and then each of those will have three different varieties (initial encounter, subsequent enco…

That's really interesting, because I had a customer that did nothing but provide medical billing services, and about 15 years ago when the industry was moving from ICD-9 to ICD-10, that customer seemed really focused on their billing coders learning ICD-10.

That's to ensure that the service provided (procedure code) matches the diagnosis.

For example, the procedure (HCPCS) code "71045" corresponds with the procedure "RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW" for billing purposes.

If you were to match that up with the diagnosis code (ICD10) S80.211 for "Abrasion, right knee" there would be a mismatch between the diagnosis and the procedure. This happens all the time due to human error and often results in insurance denials, which sadly take a long time to fix since now you have to get MORE HUMANS involved.

Re: A petabyte of health insurance prices per month

#84

Post by redandblack »

tiffanyg wrote: post #41

Because our (US) system is at Monty Python levels of absurdity. We waste more money with this "system" than most other countries spend as a total, and with worse outcomes on average [1]. Fundamentally, there are two factors, IMO, that have been conclusively proven (repeatedly, and for decades - much more strongly, recently) to be incompatible with delivering quality healthcare with some level of efficiency: 1) For-pr…

How come medicare "system" become the defacto standard

Re: A petabyte of health insurance prices per month

#85

Post by mtgx »

BaseballPhysics wrote: post #73
tiffanyg wrote: post #41

Because our (US) system is at Monty Python levels of absurdity. We waste more money with this "system" than most other countries spend as a total, and with worse outcomes on average [1]. Fundamentally, there are two factors, IMO, that have been conclusively proven (repeatedly, and for decades - much more strongly, recently) to be incompatible with delivering quality healthcare with some level of efficiency: 1) For-pr…

> We waste more money with this "system" than most other countries spend as a total, and with worse outcomes on average [1] Oh sure, if you don't measure what is obviously the most important outcome: freedom

[dead]

Re: A petabyte of health insurance prices per month

#86

Post by talldatethrow »

thomascgalvin wrote: post #15

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

I wish instead of charging 100x for random things to pay for the hospital, they'd just charge per minute of room and per minute of doctor contact.

I understand why you need to charge me $2000 to have an entire hospital ready in case I need stitches at 3am. But I get annoyed when you try to play it off as having to charge $85 for an aspirin. Just be upfront and say, we charge $100 a minute and this is going to take 15-20 minutes.

Re: A petabyte of health insurance prices per month

#87

Post by thfuran »

arcticfox wrote: post #70
marcus0x62 wrote: post #42

Earlier quoted context omitted.

If a person were sucked into a jet engine, they'd be turned into soup. Maybe they could be poured into a container and the doctor could subsequently encounter them in that state.

https://twitter.com/NavalInstitute/status/123054297912482202... Here's a video of a guy getting sucked into a jet engine and surviving. Most, of course, do die. I don't quite understand why everyone is so bothered by the extensive ICD taxonomy; it clearly needs to be extremely extensive to cover even fairly common scenarios, and once you're past the point that things can be easily managed why not cover everything?

Sure, it's necessary to have some specificity so that providers and insurance companies can be reasonably informed about what's going on, but this stuff has a very real cost. Healthcare providers have entire departments of people dealing with coding. The more complex it gets, the more time consuming and expensive it is to correctly code things. At some point (I suspect well behind us), the added cost isn't worth the marginal benefit.

Re: A petabyte of health insurance prices per month

#88

Post by shubb »

maweaver wrote: post #39
bradgessler wrote: post #20

Earlier quoted context omitted.

Here's the full list of codes for "Bitten by ____, _____ encounter" https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- The hierarchy looks like this: W61.6 Contact with duck = W61.61 Bitten by duck == W61.61XA …… initial encounter == W61.61XD …… subsequent encounter == W61.61XS …… sequela = W61.62 Struck by duck == W61.62XA …… initial encounter == W61.62XD …… subsequent encounter == W61.62XS …… sequela = W6…

But why? I could understand from a treatment perspective the type of animal mattering (but even then initial vs subsequent encounters?). From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion?

Because these are world health organisation 'international disease classification' codes that are designed for population health study and happen to be used for insurance billing in the US.

There are requirements for some data to be reported to federal and international organisations. For instance, these codes are also used on death certificates I think, so they can track whether a lot of people are dieing of flu (primary cause) after contact with duck (qualifier) and there is a bird flu outbreak.

There are many coding systems - semi-standard extensions of ICD used to identify very specific types of cancer or the ontology based SNOMED which is rarely used as intended but none the less is becoming the standard.

These codes are used for billing in the US to some extent but also for lots of other things, they are just a standardized set of codes that hospital IT systems use to talk about what is wrong with patients so they can somewhat interoperate - and they are forced to use them by government because the vendors prefer walled gardens over interoperability.

Re: A petabyte of health insurance prices per month

#89

Post by talldatethrow »

cool_dude85 wrote: post #43
pc86 wrote: post #25

Earlier quoted context omitted.

My personal favorite is V97.33XD "Sucked into jet engine, subsequent encounter."

Do we get separate diagnosis codes for each verb? So, sucked into jet engine, walked into jet engine, fell into jet engine, pushed into jet engine, etc.?

I'd hope all those fall under "made contact with jet engine internals" If you fell into a jet or were pushed into a jet are the same. You fell into it because you were pushed. If you were sucked into it, the push just came from the other side and you still fell into it.

Re: A petabyte of health insurance prices per month

#90

Post by galleywest200 »

arcticfox wrote: post #62
mensetmanusman wrote: post #53

Earlier quoted context omitted.

"I'd like to file a complaint. This is my fourth time being bitten by a duck not my second time. You have overcharged me!" This is possible in America today. Great job post ww2 employer coverage side effects!

As others have explained, the subsequent encounter is for a follow-up visit, not a repeated duck attack.

This is still silly.
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