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Specialty Hospitals Hinder Community Hospitals’ Medical Billing

Specialty Hospitals Hinder Community Hospitals’ Medical Billing

Specialty Hospitals Hinder Community Hospitals’ Medical Billing

You may not think that one hospital could affect another hospital’s medical billing, but you would be wrong. Community hospitals used to be the only hospitals around. Now specialty hospitals are popping up all over the country. These new specialty hospitals are beginning to hinder medical billing reimbursement for community hospitals.

There are several issues of debate when speaking of specialty hospitals. Routinely these hospitals get the more profitable medical cases than the community hospitals. This causes problems for the community hospitals because they use these high profit cases to subsidize their lower profit cases. Not only do specialty hospitals take money away from the community hospitals, but they also have other technical issues to deal with.

Specialty hospitals are significantly physician owned. Cardiac hospitals are 34% physician owned while orthopedic hospitals are 80% physician owned. Physician ownership can cause many problems. It brings major medical billing issue called conflict of interest. It is the worry that physicians may make decisions that are financially based rather than medically based. They also may decide to treat the more profitable patients to boost medical billing revenue. This would force the least profitable cases over to community hospitals. There is no balance, so community hospitals are left in the dust.

The government seems oblivious to the specialty hospital medical billing problem. In 2005 the Centers for Medicare and Medicaid services extended the moratorium and allowed the owners of the specialty hospitals to refer their Medicare patients to their own hospital. This is definitely a conflict of interest in the medical billing world.

Unfortunately, a medical billing loss for community hospitals will mean a lower standard of health care with less quality. While physicians and specialty hospital owners benefit, the rest of the world suffers. If only there was a way medical billing could be fair for everyone, life would be good.

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