There are two coding systems (ICD - for diseases, and CPT for procedures) that are mandated to use by medicare/medicaid and all the insurance companies use them as well. Most of them even accept the same forms. They need those billing assistants for other reasons.
”They need those billing assistants for other reasons.”
Whatever it is they do exactly it deals with insurance companies. Germany also has private doctors but they have much smaller staff and dealings with insurance are very straightforward. American insurance companies cause a lot of friction. I don’t know exactly why but they do.
Insurance companies are mainly trying to combat fraud. They kick back claims if they are formatted wrong (why did you code an operation on the left knee when the right knee was the problem), or they deem that the work done was improper, unnecessary or does not fit the standard of care. Billing staff also handle accounts receivable and collections.
The biggest problem IMO is how we structure payment for health services in the USA. The fee for service model is highly inefficient and disincentivizes preventative care. All of the current proposals for universal healthcare do not address this fundamental problem, and so long as this remains in place we will continue to have the highest costs in the world. (disclosure, I am working to try and solve this problem)
If you were to pick countries to emulate, I would pick Singapore, Japan, the Netherlands, and Switzerland instead of Canada and the U.K.
