In the US, as a doctor, you designate your patient with a “CPT Code”. These are codes that are revised annually, and there is a code for every medical procedure that you can imagine. Once the doctor has assigned a diagnosis, these “CPT Codes” are considered an “Accession”, and the insurance and billing departments of the source of treatment will parley with each other, argue and negotiate over what will be reimbursed according to contractual agreements that are drafted annually.
HOWEVER, with the introduction of COVID, the government introduced a “CPT Code” that is COVID-specific. So if a guy comes into the ER after suffering from a heart attack, and coincidentally tests positive for COVID, the doctors will assign the COVID “CPT Code”, in which case the US Federal government will reimburse the full cost of treatment.
So, if a patient is coming in for an emergency, and he tests positive for COVID, this is a fucking gold mine. They can assign the COVID CPT Code, and they collect 100% of the cost of treatment from Uncle Sam, no questions asked.
So what would you do as a doctor, who is assigned certain KPI metrics to bring the hospital revenue up? Rather than be honest and assign a CPT code for a heart attack and any auxiliary treatment, which would lead to a very costly parley and negotiation with an insurance company over what will be covered, or would you just skip the bullshit and assign the COVID CPT Code and collect 100%, no questions asked?
t. guy who works for a company who handles the billing, coding, and patient follow-up with insurance companies on the behalf of doctors. We actually had a meeting where they accused the doctors of juking the stats. If they assign the COVID CPT Code, we get nothing, since our revenue is dependent on a % of billing collections from the patient. If they use the COVID CPT Code, we get nothing, since the patient pays nothing.
US healthcare system is so fucked up beyond all repair.