According to a new study, the US is one of the most expensive countries to be paid for because of the complex coding procedures in place there.
The study, which was published in Health Affairs, compared the billing and insurance-related (BIR) expenses at provider offices in the US and five other nations using microlevel time-driven activity-based costing data.
The nations covered both multipayer systems with both public and private payers that compensate providers, as well as single-payer systems (Canada) (Germany, and Australia). The Netherlands, which offers universal and required multi-private-payer coverage, and Singapore, which reimburses providers for global budget payments using a government subsidy mechanism, were also included in the research.
The analysis supported previous studies’ findings that BIR expenses in the US are often substantially higher than those in other nations. In actuality, BIR expenses for an inpatient surgical bill ranged from a low of $6 in Canada to a high of $215 in the US. That amounted to around 3.1 percent of the procedure’s overall professional earnings in the US. Additionally, providers took roughly 100 minutes to complete the claim.
The only sites with comparable BIR costs were those in Australia. The nation offers both universal coverage and a combination of publicly and privately paid payers. BIR expenses were much lower in Canada than in the other countries, although they were similar in Germany, Singapore, and the Netherlands.
Higher costs in the US and Australia were attributed to higher coding costs, researchers found.
“We observed that high US costs are caused primarily by expensive and extensive coding activities, not higher wages paid to US personnel,” they wrote in the study.
Meanwhile, hospitals in Canada, Germany, Singapore, and the Netherlands had much lower coding-related costs. Researchers said the finding suggests that the US could achieve savings by “simplifying and standardizing payment procedures.”
Although the healthcare systems in the aforementioned nations may differ greatly from one another, researchers found that coding was a consistent theme. Every nation has national institutions that regulate how payers pay providers. Providers in countries like Canada, Germany, and the Netherlands, for instance, have a set list of fees similar to Medicare’s diagnosis-related groupings (DRGs). Most billing codes’ contract terms are also the same for payers in Germany and the Netherlands; only a tiny portion of billing code pricing is established through agreements between payers and providers.
It is extremely difficult for physicians to convert clinical paperwork into billable codes for reimbursement in the US because each payer has its own forms and documentation requirements.
