If you have ever wondered how medical care is organized, the answer is not so simple. The best way information can be connected within a medical system is to have medical record codes and other codes for insurance companies to determine what amount a physician will be reimbursed for a certain procedure. This is called Current Procedural Terminology (CPT) and is a means of categorizing treatments, the physicians involved, protocols, and payouts to medical facilities. The information has to be organized in this manner in order for all cases to be clearly identified.
For example, there will be a CPT code for each cohesive aspect of cardiac care and diagnosis. This is a complex matter with many procedures performed to stabilize the condition. The doctors you get will have accountants who work with insurance companies to maximize reimbursements for patient care. The goal is to get paid, ultimately. The amount that is paid for each protocol will be based on the various CPT codes used in the medical records. Otherwise, how would we keep all of this information cohesive and practical to access?
In cardiac care, you will see cpt code 93306 for the protocols of echocardiography as well as transthoracic, and Doppler imaging. It includes some other aspects as well. Each successive code and each previous code has a special designation and you may see a reimbursement of a certain amount. This amount will vary from one insurance company to another, but it tends to stay the same for longer periods of time than Medicare. Regardless, physicians are still looking to earn as much as possible to cover their losses. As a result, the level of medical care administered will be different for each case.
In reference to the code above, a cardiologist will get a certain amount from Medicare for that group of tests and patient cost would be determined from there. Ideally, practitioners do not want to compromise services. At the same time, they can only work with the resources they have. This is part of why Medicare is mainly used as supplemental insurance. The reimbursements are not as high as with major insurance companies.
As all of this may sound confusing, it works from a basic economic level. Tests and procedures require resources and resources cost money. Where is the medical system going to get equipment and supplies for free? They don’t. The healthcare facility they work for does. Here we go into the territory of hospital administration where the patients do not have faces and they are just numbers. When all the numbers come together, you either have approval or you do not and then move on to the next step.
Have an insurance specialist teach you more about this subject or learn more about it online. Essentially, the CPT codes work to organize the structure of medical care in a cohesive and practical manner. As long as the right codes are used for the proper patients, these codes assure total and proper care to the patients involved.