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Post by vintagecomics on Feb 19, 2021 11:06:22 GMT -8
I appreciate the posts by Ditch and you. It is an interesting situation. I would hope the same as everyone that the "herd immunity" occurs within the projections stated. This is a great conversation. I am very familiar with the good Doctor. From my awareness and perspective of the wampum involved and adjudication reviews ( the wampum source), there is not an overwhelming opinion that we, and the world, will be fortunate to the level the good Doctor predicts. As i mentioned, in some jest but a kernel of truth, somebody has to get paid for something by somebody, and the $ have to come from somewhere. Consider an important element needed in the vaccine production, that we learned in the last 2 days is not available at this time. A crucial time. It would be interesting to project the herd immunity in long term care facilities, and when it will be sufficient so the medieval treatment practices of these patients can be stopped. After all, they are not lepers....yet. There's a lot of moving pieces that haven't come together yet.
There's the guestimated 20% immunity that was talked about last early summer that some of the population may have had from previous Coronavirus infections and I haven't heard anyone talk about that since last summer.
Then there's actual Covid-19 exposure which is much greater than the official infection numbers indicate.
Then there's vaccinated folks.
Then there's Florida, whose reopening does not seem to be affecting infection numbers (to my knowledge) and is not the zombie apocalypse everyone expected.
As I said on the CGC forum, I don't think history will look nearly as favorably on the pandemic response as most pro-lockdown people today think it will.
Do you have any statistics on suicides, overdoses and other collateral damage from the lockdown measures?
I never have any great success when I search the CDC site for such info.
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parker1865
TCBF Member
Joined: September 2018
Posts: 1,325
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Post by parker1865 on Feb 19, 2021 11:28:51 GMT -8
I appreciate the posts by Ditch and you. It is an interesting situation. I would hope the same as everyone that the "herd immunity" occurs within the projections stated. This is a great conversation. I am very familiar with the good Doctor. From my awareness and perspective of the wampum involved and adjudication reviews ( the wampum source), there is not an overwhelming opinion that we, and the world, will be fortunate to the level the good Doctor predicts. As i mentioned, in some jest but a kernel of truth, somebody has to get paid for something by somebody, and the $ have to come from somewhere. Consider an important element needed in the vaccine production, that we learned in the last 2 days is not available at this time. A crucial time. It would be interesting to project the herd immunity in long term care facilities, and when it will be sufficient so the medieval treatment practices of these patients can be stopped. After all, they are not lepers....yet. There's a lot of moving pieces that haven't come together yet.
There's the guestimated 20% immunity that was talked about last early summer that some of the population may have had from previous Coronavirus infections and I haven't heard anyone talk about that since last summer.
Then there's actual Covid-19 exposure which is much greater than the official infection numbers indicate.
Then there's vaccinated folks.
Then there's Florida, whose reopening does not seem to be affecting infection numbers (to my knowledge) and is not the zombie apocalypse everyone expected.
As I said on the CGC forum, I don't think history will look nearly as favorably on the pandemic response as most pro-lockdown people today think it will.
Do you have any statistics on suicides, overdoses and other collateral damage from the lockdown measures?
I never have any great success when I search the CDC site for such info.
I sort of concur with the missing pieces. Concerning stats, it is important to realize that CDC does not have a thing to do with adjudication and incidental coding/treatment modalities, because of.....I know, I know.....billing to the highest order claims. The stats you are interested in, and so am I and so are healthcare insurance providers and healthcare facilities, and healthcare providers (all disciplines) is an impossible task, at this time, because the percentage of claims in adjudication is a nightmare, and a sticking point is coding/billing that is considered incidental to the claim, due to the global period exception. The global period (and I will keep it simple): a patient comes in with a laceration to the finger and requires a surgical procedure. The patient is treated. The patient returns in a week and is seen. Everything is ok. Patient returns in 3 weeks with pain. Patient is checked out. Just normal healing booboo. Healthcare provider bills for the second and third visit. Nope. Both f/u visits fall within the 30 day global period. The healthcare provider owns it. The appeals process starts. Remember, the patient can't be billed for a global period denial. Extend that simple explanation to a CV19 patient. Things are going to get dicey for everyone involved. So, adjudication takes over, and starts the records request/documentation and/or denial and appeals process. That is where things are, now. |
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Post by vintagecomics on Feb 20, 2021 15:31:41 GMT -8
There are facets of the pandemic that I would never even begin to think about. I can only imagine how many people have stories to tell along these lines.
Because of the boarder crossing rules due to the pandemic he's stuck in the US, her car is stuck in Canada and it's impounded until she pays for a year of parking.
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Post by Stu on Feb 20, 2021 15:56:45 GMT -8
There are facets of the pandemic that I would never even begin to think about. I can only imagine how many people have stories to tell along these lines.
Because of the boarder crossing rules due to the pandemic he's stuck in the US, her car is stuck in Canada and it's impounded until she pays for a year of parking.
I like the Freudian slip "boarder crossing rules". Those are the rules you broke Roy! |
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Post by vintagecomics on Feb 21, 2021 11:50:09 GMT -8
There are facets of the pandemic that I would never even begin to think about. I can only imagine how many people have stories to tell along these lines.
Because of the boarder crossing rules due to the pandemic he's stuck in the US, her car is stuck in Canada and it's impounded until she pays for a year of parking.
I like the Freudian slip "boarder crossing rules". Those are the rules you broke Roy! This is a fabricated lie.
The boarder is open for work related travel. It's only closed for non-essential travel which means you can't travel across the boarder for pleasure. For work there are no restrictions.
Like Jaybuck and the rest of the CGC board members you're completely clueless and have no idea what you're talking about.
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Post by Stu on Feb 21, 2021 12:11:32 GMT -8
I like the Freudian slip "boarder crossing rules". Those are the rules you broke Roy! This is a fabricated lie.
The boarder is open for work related travel. It's only closed for non-essential travel which means you can't travel across the boarder for pleasure. For work there are no restrictions.
Like Jaybuck and the rest of the CGC board members you're completely clueless and have no idea what you're talking about.
Yeah I knew you couldn't put me on ignore  Let me clue you in Roy. Comics are not essential. Selling comics is not essential. Buying comics is not essential. You are not essential. Your "job" is not essential. Your entire existence is non-essential. You can claim the loophole but morally and ethically you don't have a leg to stand on. Anyone who crosses an international border to buy comics is a scumbag plain and simple. |
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Post by vintagecomics on Feb 22, 2021 4:57:37 GMT -8
This is a fabricated lie.
The boarder is open for work related travel. It's only closed for non-essential travel which means you can't travel across the boarder for pleasure. For work there are no restrictions.
Like Jaybuck and the rest of the CGC board members you're completely clueless and have no idea what you're talking about.
Yeah I knew you couldn't put me on ignore Let me clue you in Roy. Comics are not essential. Selling comics is not essential. Buying comics is not essential. You are not essential. Your "job" is not essential. Your entire existence is non-essential. You can claim the loophole but morally and ethically you don't have a leg to stand on. Anyone who crosses an international border to buy comics is a scumbag plain and simple. You know, every single person who has joined this forum by my invitation asks the same question. They ask me who that loser Weasel Stomper is. 
This is a perfect example of you being intellectually dishonest - basically, a hypocrite. You take something that is not true and you accuse someone.
Nobody said comics were essential. That's just a made up phrase that people on the CGC forum used to pick a fight. If you were interested in what was true you'd actually read the rules for boarder crossings and see that you are completely wrong.
What is considered essential is any work related travel. What is not considered essential is pleasure related travel. There are 1000's of people who cross the border every day for WORK and it's legal and allowed. I crossed for WORK.
Whether you think me working to support my family is essential or not is about as relevant to me as anything else you say.
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Post by Stu on Feb 22, 2021 5:21:14 GMT -8
Yeah I knew you couldn't put me on ignore Let me clue you in Roy. Comics are not essential. Selling comics is not essential. Buying comics is not essential. You are not essential. Your "job" is not essential. Your entire existence is non-essential. You can claim the loophole but morally and ethically you don't have a leg to stand on. Anyone who crosses an international border to buy comics is a scumbag plain and simple. You know, every single person who has joined this forum by my invitation asks the same question. They ask me who that loser Weasel Stomper is. Yeah your legions of fans you have just deluged this board with new memberships so many new people I can't keep them all straight. Don't worry, you legions of fans will be here shortly to defend you from the big bad stomper. Oh wait, that's not going to happen... more people hate Roy than hate me  |
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Post by vintagecomics on Feb 22, 2021 6:03:37 GMT -8
There's a lot of moving pieces that haven't come together yet.
There's the guestimated 20% immunity that was talked about last early summer that some of the population may have had from previous Coronavirus infections and I haven't heard anyone talk about that since last summer.
Then there's actual Covid-19 exposure which is much greater than the official infection numbers indicate.
Then there's vaccinated folks.
Then there's Florida, whose reopening does not seem to be affecting infection numbers (to my knowledge) and is not the zombie apocalypse everyone expected.
As I said on the CGC forum, I don't think history will look nearly as favorably on the pandemic response as most pro-lockdown people today think it will.
Do you have any statistics on suicides, overdoses and other collateral damage from the lockdown measures?
I never have any great success when I search the CDC site for such info.
I sort of concur with the missing pieces. Concerning stats, it is important to realize that CDC does not have a thing to do with adjudication and incidental coding/treatment modalities, because of.....I know, I know.....billing to the highest order claims. The stats you are interested in, and so am I and so are healthcare insurance providers and healthcare facilities, and healthcare providers (all disciplines) is an impossible task, at this time, because the percentage of claims in adjudication is a nightmare, and a sticking point is coding/billing that is considered incidental to the claim, due to the global period exception. The global period (and I will keep it simple): a patient comes in with a laceration to the finger and requires a surgical procedure. The patient is treated. The patient returns in a week and is seen. Everything is ok. Patient returns in 3 weeks with pain. Patient is checked out. Just normal healing booboo. Healthcare provider bills for the second and third visit. Nope. Both f/u visits fall within the 30 day global period. The healthcare provider owns it. The appeals process starts. Remember, the patient can't be billed for a global period denial. Extend that simple explanation to a CV19 patient. Things are going to get dicey for everyone involved. So, adjudication takes over, and starts the records request/documentation and/or denial and appeals process. That is where things are, now. So you're saying that the majority of statistics in the US are still not confirmed as they are derived from the billing system and I can understand that. That makes perfect sense because it's a business.
We had a similar system in the automotive industry.
A doctor visit is similar to an autoshop visit and warranty repairs are audited to make sure people weren't scamming the insurance system that was paying for the repairs...and it's easy to understand why.
The money is huge.
We touched on this last summer and some of the usual suspects (and a few unusual ones  ) chimed in with plenty of hate when I wrote what I did.
The medical industry is like any other. It's a system designed to make money and in any system those involved are going to try to make as much money as they can. ANY system that is designed to make money you will have some corruption.
If you're getting paid $8000 for a Covid treatment and $30,000 for an ICU treatment the incentive is there for medical facilities to charge whatever they can to get paid.
Your phrase 'bill to the highest order' is basically a nice way of saying 'bill for everything you can possibly get paid for and then upon audit see what they allow and what is not allowed will get kicked back'
Do you have any statistics on what percentage of billing submissions don't pass the adjudication or audit stage and get kicked back annually?
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parker1865
TCBF Member
Joined: September 2018
Posts: 1,325
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Post by parker1865 on Feb 22, 2021 7:15:49 GMT -8
The norm....and I will use the ACA implementation starting date for the reply.....has been 9-20%. This is not all that unusual, and it was explained about a year ago, in the original thread.
In general, a healthcare provider would submit a billing of, say, $200 for a new patient visit. CMS allows $160 and this figure varies year to year depending on cost adjustments. United allows $120. BCBS allows $130. The healthcare provider need not be credentialed with these payers, in order to receive payment, but has to agree to accept the amount, and the patient is responsible for the balance. But, the healthcare provider has to be consistent with the charge, because if CMS is billed for the allowed $160, and then the same healthcare provider bills $200+ to another payer, the healthcare provider does not automatically get a home free card, because the other payer asks, why are you billing x payer at the x fee for service rate, and billing me higher?
But, in general, the provider credentials and is contracted with the payer and has to accept whatever the payer allows for the coding charge submitted. The problem comes into play when the patient is cash pay, or the patient does not have insurance....and realize that many patients have insurance but the deductible is so high that the patient prefers to pay cash, or many patients have only catastrophic coverage and have to pay out of pocket....and therefore the patient is responsible for the balance. How is that "enforced": because the patient agrees to be responsible if the insurance does not cover the cost(s). The patient had to sign the financial responsibility agreement at intake. If the provider is credentialled, and agree to the payers rates, and agrees not to bill the patient for the excess, the excess is written off. This is the #1 misunderstanding when a patient receives the adjudication and payment advise document from their insurance company, and sees the the provider billed, say, 200 and the insurance only allowed 120, and the patient automatically assumes the provider 1) tried to cheat, 2) the patient is going to be responsible fo rthe balance because the provider "lied" about accepting the insurance, or 3) the insurance company is not paying the bill like they are supposed to do.....and of course none of that is true. But, the all doctors are millionaires and cheats and don't do anything rumors start.
So, why consistently use the same rates? Because then the provider is not going to have problems of unfair practice billings, and also has a basis for write-off, and more importantly, has a contract negotiation basis for allowed pricing upon credentialing or for credentialing renewal.
So, back to the question, after that explanation: the present rate is averaging 36-38%, since 10/2019.
The adjudication backlog is 60% during that period.
I think I have covered your questions, as simply as I could.
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Post by vintagecomics on Feb 22, 2021 7:28:05 GMT -8
And you did it with capital letters and punctuation! 
Thanks!
just to clarify, so about 60% of billings are awaiting adjudication but 36-38% of them are being rejected?  |
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Post by Ditch Fahrenheit on Feb 22, 2021 7:40:46 GMT -8
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Post by Stu on Feb 22, 2021 8:07:51 GMT -8
A) Do not respond, as this may be viewed as participation.Interesting 
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parker1865
TCBF Member
Joined: September 2018
Posts: 1,325
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Post by parker1865 on Feb 22, 2021 8:36:31 GMT -8
And you did it with capital letters and punctuation!
Thanks!
just to clarify, so about 60% of billings are awaiting adjudication but 36-38% of them are being rejected? YES I DID. I NO LONGER CARE ABOUT PISSING OFF DONUT BY USING CAPS AND PUNCTUTION IN A MANNER THAT HE.....(AND TFITZ, WHO WAS CLUELESS ABOUT WHY I DID SO).....DEEM APPROPRIATE AND THAT DONUT FREQUENTLY COMPLAINED ABOUT AD NAUSEUM FOR NO OTHER REASON BUT TO BELITTLE AND THAT OFFENDED THE SCHOLASTIC ACHEIVERS BECUASE THEY JUMPED ON THE DONUT SHAMING BAMNDWAGON AND THAT NEVER DID PAY ATTENTION TO MY PUBLICLY STATED INTENT TO NOT USE CAPS, JUST TO  DONUT OFF. BY DOING SO, DONUT STOPPED HIS BS, AND SINCE I ALSO PUBLICLY STATED THAT I WILL NOT INTERACT WITH TFITZ I THINK I AM GOOD TO RETURN TO MY PREVIOUS SCHOLASTIC QUALITY LEVEL OF POSTS IN THE AREA OF CAPS AND PUNCTUATION. to avoid having to edit and to plagiarize without stating i am doing so, as dr. king stated and i paraphrase: "free at last, thank god i am free at last". As to the clarification; no, 60% are awaiting review/adjudication on initial billing, of which 38% are in appeal, after being adjudicated, or are finalized and paid at the adjudication decision rate. |
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Post by vintagecomics on Feb 22, 2021 8:45:05 GMT -8
This post is due to a PM discussion I'm having with someone.
I'm still perplexed as to how ANYONE can still say that Fauci didn't say not to wear masks back on March 8th 2020 on the 60 minutes episode. 
(Sorry about the link to the political site but it seems that the video has been scrubbed from most places online - go figure - more whitewashing of the past)
Even the Fact Checkers themselves admit that Fauci said not to wear masks back in March 2020 and it wasn't just Fauci, it was Jerome Adams the US Surgeon General at the time.
So it's really simple, either Fauci lied to the public to save masks for workers or he genuinely didn't believe they'd be effective at the time. But either way, there was an about face as witnessed by all the fact checker sites.
Those people denying Fauci's words are the same people who twist words and move goal posts to suit their own needs in this fight on the pandemic and they do so NOT because they're interested in what's true and real, they're just interested in their own leanings and biases.
The reason this is important is obvious. If the general public can't keep their leaders and officials accountable and we can't agree on simple truths that are as black and white as salt and pepper then we're doomed as a society because you can't problem solve and move forward with no standard for what truth is.
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) chimed in with plenty of hate when I wrote what I did.
DONUT OFF.
