The way we buy and bill for healthcare via the third-party claims-based insurance model has resulted in near complete suppression cost-value signals that normally allow buyers and sellers to establish a meaningful trading point, called the clearing price. This efficient market mechanism helps ensure that each participant reaches their best position without causing the deal to fall apart. Absent these efficient market forces, it is no wonder healthcare costs have skyrocketed during the reign of the third-party billing cartel.
The mandatory use of CPT/ICD billing codes in all medical insurance billing is at the heart of this economic dysfunction. It has become a self-perpetuating system propped up by biased tax laws favoring employer-sponsored insurance and overly restrictive insurance regulations, both contributing to the “job-lock” dilemma.
Houston, we have a coding problem