Description
Book Synopsis Warren Buffett famously invoked the metaphor of a tapeworm when describing what healthcare is to the American economy. The United States spends approximately 20% of its gross national product on healthcare, but it is unclear where the money goes or who is minding the store. This healthcare crisis is mostly about money--not lack of money, but rather misspending of money.
From the perspective of a healthcare auditor and provider, this work describes the problems of American healthcare finance and proposes solutions. Extensive charts and graphs are used to trace where money goes in the American healthcare system, while other topics such as ethics in healthcare billing, un-auditable hospital costs and scams are discussed. There is evidence that clearly identifies where the money goes, and its destination may surprise the reader.
Table of Contents
- Table of Contents
- Introduction by Lisa Famiglietti
- Tables, Charts and Maps
- 1. Death Rode a Pale Horse in 2020
- 2. The Medicaid Cluster
- 3. Where Does the Drug Money Go?
- 4. Money, Politics, and Data
- 5. Required Profits and MCOs
- 6. Coding and Billing
- 7. The Curious Case of CPT Code 92507
- 8. Curiouser and Curiouser
- 9. Managed Care Organizations: Down the Rabbit Hole
- 10. Regulations and Estimates
- 11. Regulation Failures: Third-Party Recovery and Site-Neutral Requirements
- 12. Cost-Shifting and the Flip and Roll
- 13. Scams with Teeth, Regulations without Teeth
- 14. Solutions for Unauditable Hospital Costs
- 15. Unnecessary Surgeries and Tests
- 16. Ethics in Healthcare Billing
- 17. Adding Up the Costs
- Chapter Notes
- Bibliography
- Index
