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Author: Stonewashed Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 1947351  
Subject: Re: Never say die. Attack on Obama(care) Date: 10/31/2013 8:16 AM
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Doctor's offices have had to hire legions of insurance coders just to make sure that they eventually get paid a fraction of what they charge for their services. Even experienced coders face frequent changes in coding. This is virtually every doctor, every medical facility across America. Do you really think that an insurance industry that has spent so many dollars fighting this law wouldn't take the opportunity to make an already massively complex structure even more so, so that they could have one more shot at getting it repealed?...
Call you local primary doctor's office and see if they have any problems with timely payments or with insurance companies rejecting claim for service because of coding issues, etc. Then imagine that same industry turning its full experience for delaying payments and complicating the coding of procedures performed against one source. Think it through and don't start drinking the KoolAid now.


And if that one source is archaic?

The issues are unlikely to be mere coding errors, but stem from the way the modules are constructed to speak to different systems and networks.

This is especially true when it comes to communicating with the state Medicaid systems, which are often decades behind current IT standards. Some are still operating on the COBOL programming language.

It is likely that large chunks of this middleware will need to be re-written, or was never firmly in place form the start.

For a crude analogy, remember how hard it is to get electronic health records to speak to each other and to different health system software. The exchange challenges, in some respects, are a similar task, albeit made easier because you are not dealing with so many lines of discrete health information (although at least health information has been largely standardized. A lot of the payer-based information that the exchanges are passing back and forth, especially with the state computer systems, doesn’t exist in any standard format).

These kinds of interoperability issues are revealed by where the biggest problem exists right now: With the program that calculates the subsidies that consumers are offered, to help reduce the cost of Obamacare.

These calculations are dependent on the ability to query across the different systems at the IRS, HHS, DHS, and state agencies, among others.

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