Doctors, hospitals, medical device manufacturers, etc., are never happy with their reimbursement.

Doctors long for the time when they could make close to $1M annually doing a few hip and knee replacements a week, along with all the other tests they can pile on.

Yes - on the health-related sites. But not the ABCs, CBSes, NBCs, CNNs, or MSNBCs, etc.

SCOTUSBlog mentions it since they cover the daily goings-on at the Supreme Court.

Roll Call - which focuses almost exclusively on Congress (and publishes the Congressional Quarterly) had it (which is the OP source).

That includes Democratic and GOPer administrations.

which may be on the chopping block soon, it SHOULD BE NEWS, considering what has already been happening with it at the moment. For example, the negotiation process for drug prices has already been changed under this new administration and who knows what else might change.

This is not a trump/musk/Kennedy conspiracy to gut Medicare. Don’t know for sure, but the case probably started back in Biden’s admin.

However like a number of cases coming through now that go back to a time during or even before the Biden administration, you are now seeing a reversal of how 45's DOJ is handling them (and that is who represents HHS as I used to work for a HHS agency and we worked with DOJ by providing evidence for any compliance issues that needed legal action including seizures, etc).

It behooves to monitor what happens with the cases that are "in progress" and being decided rather than dismiss it out of hand.

We’re actually human beings who care about treating people. Doctors never made close to 1 million annually doing a few surgeries a week, nor do we try pile on tests that are irrelevant to an evaluation and won’t get reimbursed by private OR public insurance. Not sure where you get your info from, but it’s not from the real world, and I’ve been in the business for 35 years.

a million bucks in today’s money on something that could be done in a day, more likely two surgical sessions. Nowadays, they’ve invested in surgical centers, scanners, and every other money maker.

I find the whining from providers doing well humorous.

I do admire those docs who cater to Medicaid and uninsured patients. They still make a decent living, but ain’t in it for the money.

Medicare reimbursement woefully lacks real world costs of the provider.

HCPC. That is what the general public has zero knowledge of. Health Care Procedures Coding.

With Medicare, every procedure, treatment, and equipment piece/replacement part has a code assigned. The code associated with any of the aforementioned has a specific reimbursement amount. Period. So if any procedure, treatment, or equipment/replacement part costs the provider more than the code allows reimbursement for, the provider takes the loss. When the primary payer of any provider is Medicare, they operate in the red. And cannot survive.

When a provider has a majority of private insurance providers paying, that provider can stay afloat.

The real issue here is Medicare needs to increase reimbursement by HCPC code, regardless of who the provider is.

As an example, for wheelchair repair (my job), from 1994 to 2017 the HCPC K0019, wheelchair arm pad, meant ALL arm pads. Even it it was a custom molded arm pad designed to keep a quadriplegic's arms in control, and not flopping outside the chair frame. Molded arm pads can cost the provider hundreds of dollars each. From 1994 to 2010 HCPC K0019 reimbursement was $9.50 each.

So in 2008, when my company paid $220 for a molded arm pad, Medicare paid us $9.50.

This is an issue Congress needs to address.

Sounds similar to what someone I know who works in medical field told me a few weeks ago.

Is not billing for excessive procedures, treatments, equipment and parts, it is billing for such that was not provided. No cost to the provider committing the fraud.

The military might pay $500 for a toilet seat, but that seat was actually bought. Medicare fraud is what was billed but not actually done.

But from my corner of healthcare, I repair existing equipment, it really doesn't exist. But I am sure it happens in other corners...

are other codes that pay very well, sometimes considerably more than one can buy it on Amazon.

An example of such a lucrative code.

I got into this business in 1998. And in more than a quarter century, I've yet to see a profit on any government payer invoice. Medicare. Medical (Medicaid) Tricare (the military version of government insurance), there are those who turn a profit through fraud, billing for products and services not actually provided. I am interested in this/these HCPC codes that pay "very well". If Amazon charges more, for self diagnosed equipment, I really want to know about it.

DME does well, and Medicare often pays better than private insurers.

Of these 'phantom' lucrative codes.

Do you work in healthcare, in any capacity? What intricate knowledge do you possess about medical billing? Or of medical reimbursement?

though not excessive by any means. Appreciate your critical work.

Most DME Suppliers, doctors, hospitals, etc., who complain they are losing money from Medicare are exaggerating at best. They might not be making what they want, but that’s different. Medicaid is not much more than contributing to overhead, but tons of providers do well with a substantial Medicare patient base.

As one who actually works in the industry, I can tell you that statement is incorrect. HCPC reimbursement is substantially less than costs. We are bound to accept those patients to keep our license. Regardless of financial loss. It is private, not public, payers who keep the lights on.

In any event, I appreciate the services you provide to patients.

I just don’t think most healthcare providers are doing as bad as they claim when trying to get their reimbursement increased. There are doctors and other professionals who work in clinics for uninsured, poor, etc., who are excepted.

Because I don't.
When you operate at a loss, you go out of business. Period .
I have made a career of doing only what is necessary to keep my clients moving. But I am aware that to keep the business moving we need to make a profit. To be eligible for mobility equipment, the Medicare standard is: 1 medically necessary, and 2 the least expensive option.
I have consistently adhered to both criteria.
And I can assure you, there is zero profit there
If it were not for private insurance payers, my company would not exist.

I assume you are a small DME company or similar. “Need profit to keep company moving” doesn’t mean a lot when owners are doing well. I suspect your company makes a decent profit, that is taken out with salary. Lower the salary, profit o keep moving increases.

Cracks me up when some doctor making $500k, whines about not making enough to hire a medical assistant at a decent wage (when that assistant helps them see 5 more patients a day or an extra $1000 a day on average). I know you are not an MD, but their whining always cracked me up.

My real point is that we are trying to keep Medicare from getting gutted. Maybe Democrats proposing big increases in reimbursement is not a good idea right now.

Not that I expect most providers to stop whining. I’ve heard it for 50 years, even when Medicare/Medicaid essentially paid what providers billed. Interestingly, those provider bills increased substantially almost every month once they realized that.

Fair compensation for my endeavors. And I want the same for my employers. What I don't want is the government telling me I have to provide goods and services at a financial loss

Charity has its place. But when it threatens my daily life, and my future life, I draw a line. Fairness is absent with Medicare. It's taxpayer's money. So they have a tight grip. What they fail to recognize, is that those that are the providers, are the taxpayers.

I would much rather pay for healthcare, than munitions to foreign allies.

in my opinion.

Preserving the program, increasing covered people, maybe Medicare-for-All is more important than helping providers doing well, do even better. Sorry.

Is that some providers may end up insolvent due the Medicare reimbursement rules. And I agree. Wholeheartedly. Because I see it everyday.

Again, for clarity, Congress needs to address this.

when Medicare is teetering on the chopping block?

Where do you see it. I’ve worked with just about every healthcare provider for over 50 years.

Except for pediatricians and doctors/providers who devote their practice to Medicaid and uninsured, the only ones I’ve met who were really hurting were the ones who were charged with Medicare fraud for taking advantage of the system, screwed over their spouses, got license sanctioned, had significant health/disability issues, molested a patient, and similar.

under Biden. Do I need the sarcasm thingy?

Have we lost our minds?

nor realized that there was an administration change. Point being that one needs to monitor what is going on with Medicare in general for the future and that includes any suits related to it.