In the USA, most clinical encounters generate International Classification of Disease (ICD), version 9-CM, codes as a mechanism for billing for a given procedure, test or clinical visit.
For example, the number of dementia sufferers is growing, and, for any given procedure, those with the condition stay in hospital twice as long as those without.
Typically, doctors and hospitals receive twenty or thirty per cent less from Medicare for a given procedure than they do from private insurers.
The Cleveland Clinic, for example, has about a hundred different contracts with insurance carriers, each with a different rate for a given procedure.
What was probably more surprising to most readers was the huge price differentials for identical procedures — not only across the United States, but even within American cities, where prices for a given procedure can vary tenfold.
To determine how much of the medical bill they will pay, insurers calculate the so-called reasonable and customary charge for a given procedure or medical service and then pay a percentage of that amount, which is frequently much less than the doctor's or hospital's actual bill.
Medicare then decides how much to pay for a given procedure by multiplying the RVU by its annual "conversion factor" (about $37), adjusting for geography (because life is more expensive in New York than in Kansas), and adding a little for malpractice insurance.
Specialty hospitals' financial success is part of what rankles their large competitors, especially given that they get paid the same for a given procedure.
effective dose for the mentioned procedures (neither expressed as typical doses for a given procedure nor based on their own calculated radiation data).
