Grace Stroud: Pay possibilities

March 19, 2014 

If I understand the new plan for Medicaid reform correctly, officials will try to quantify qualitative services to determine whether the services had a positive outcome for the individual.

I am not a statistician, but I have friends who are and would love to hear them weigh in. It seems that with all the CPT/ICD-10 codes used and services rendered, this would be an almost impossible task for an administration that cannot send out food stamps to people who have received food stamps for years.

Imagine the system it would take to organize the data, read and code it, and then interpret it to determine whether someone like me (a Medicaid provider) gets paid for my services! And, in the end, will the people who really matter get the appropriate services if physicians or other providers are afraid to use sophisticated equipment or tests to help rule out problems? That is, if providers don’t identify the problem and/or help the individual, will they get paid or will it be considered a waste? Am I over-reacting? Am I understanding this correctly?

Grace Stroud


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