Medical Billing Coding Demystified, 2nd Edition by Marilyn Burgos Donya Johnson Jim Keogh

Author:Marilyn Burgos, Donya Johnson, Jim Keogh
Language: eng
Format: epub
Published: 2019-03-26T16:00:00+00:00

4. The Marketing Game

The business of healthcare has undergone a dramatic change in recent years. Healthcare providers can no longer set fees freely because medical insurers may not pay those fees. A healthcare provider can refuse to accept terms set forth by medical insurers; however, there is a high probability that their patients will find a healthcare provider who accepts the medical insurer’s terms rather than pay more than is required for a medical procedure.

Many healthcare providers are feeling the squeeze and seeing their incomes drop compared with the time before medical insurers negotiated special terms with healthcare providers. As a result, some healthcare providers have turned to marketing techniques traditionally used by consumer-product companies to increase their business—and their income.

No doubt you’ve heard commercials for hospitals that tout how well they rank among other local hospitals. They go straight to the patient for new business rather than rely on physicians. Traditionally hospitals pitched their services only to physicians who then sent their patients to the hospital for medical procedures. The patients had little choice because their physician was usually associated with one or maybe two local hospitals.

Practically all hospitals have negotiated terms with most medical insurers, making them an in-network healthcare provider. This means that patients receive the best possible fee according to their medical coverage regardless of the hospital. Likewise, many physicians who are in-network are associated with in-network hospitals. The patient now has the capability to choose which hospital will perform the medical procedure.

Hospitals use the airwaves and print media to convince patients that their medical facility is better than other local hospitals. Furthermore, hospitals and other medical facilities create new or enhanced services and then try to persuade patients to buy those services.

For example, in some areas of the country, medical facilities tell patients to undergo a full body scan to find tumors and other abnormalities long before symptoms appear. The full body scan is priced at the cost of a 3-week family vacation. The scan is probably not covered by medical insurance because it isn’t medically justified. That is, a physician didn’t recognize symptoms first before ordering the diagnostic test.

Consumer marketing techniques overcome this problem by convincing patients to directly pay the cost of the procedure—your life might depend on it. They even offer financing plans. Physicians point out that in rare cases this might be true, but for most people the full body scan is an unnecessary medical procedure unless the patient shows symptoms of a disease.

In fact, physicians have said that the body scan is likely to find abnormalities such as growths that normally occur in most people but have no negative effect. However, the patient is likely to incur additional medical procedures if these abnormalities are revealed by the full body scan. And this means more business—and more income—for the facility that performed the full body scan and for physicians who are associated with that facility. Medical insurers likely cover those additional procedures because the discovery of the abnormalities provided the medical reason for further procedures.

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