At the end of the day I think we all acknowledge that single payer is the optimal setup, but that’s not to say that there aren’t incentives on the provider side to maximize their payout.
While insurers have denials as their lever, providers have full coding and revenue cycle teams to ensure that they’re charging as much as possible. Both sides of the equation need to be addressed to bring costs down.
So a more sophisticated form of upcoding?
Yes, exactly that.
At the end of the day I think we all acknowledge that single payer is the optimal setup, but that’s not to say that there aren’t incentives on the provider side to maximize their payout.
While insurers have denials as their lever, providers have full coding and revenue cycle teams to ensure that they’re charging as much as possible. Both sides of the equation need to be addressed to bring costs down.