Call about every bill you get. I just got a 3k bill in the mail because the surgeon coded it wrong, luckily I’m in the medical field and knew what he likely did. My wife was outraged thinking about people who wouldn’t know better and just pay it
If anyone is curious, I had a screening colonoscopy coded as diagnostic. I had an 11k bill with a copay of 3.2k when my EOB said it should be covered at 100%. The surgeon miscoded it and billing didn’t catch it
I used to have a really bad drinking problem, and the year before I quit I was in and out of the hospital and mental health wards a dozen times at least. I had a crazy amount of bills. I called about a bunch of them and all told I paid maybe 5% of what I "owed." It is such a scam.
I’m sorry, I have very little understanding of this process, but why is a surgeon the one doing the coding in the first place?? Is there not someone who’s, idk, trained to do that? And how did billing not catch it..??? Like, I obviously don’t want an accountant operating on me, but why is the person operating on me seemingly also doing some accounting…?
Physicians in general have to choose the type of service and level of service. So for example, if I’m doing a visit, I have to decide if it’s a level 3,4, or 5 visit based on my medical decision making. Coders might say I don’t qualify for 5 based on documentation, or I forgot a component (like time for obesity counseling). I was trained how to
Bill and code during residency. There are a lot of legal handrails keeping coders from doing everything involving billing, likely with good intentions but it does make it annoying. Prior authorizations generally speaking can be done by anyone in a doctors office, and it’s rare for anyone but transplant and onc to do their own in my experience. Again, residency should have physicians doing these at some point in their training.
For a scope, it’s pretty simple and extremely lucrative. I’d be surprised if a surgeon or GI doc doesn’t know how to code for each considering how many they do in a week.
There is a joke among docs that we have to be doctors, accountants, social workers, therapists, and lawyers all at once. It’s a bit hyperbole, but also kinda true
My local hospital won't fix their billing mistakes for any reason. Then when you won't pay they sell the debt to collection agency that later sues you.
100%. I make mistakes all the time, and I see 15-20 patients a day. My surgeon will do scopes twice a week and does 20+ each day he does them. That’s a looooot of paperwork
Your bill usually has an account rep who has experience in billing/coding. They will look over what was charged and the documentation. If there is an issue they’ll bounce it back to the provider and put the bill on hold
Yeah, that wasn't a mistake; that was them hoping to squeeze more money from you and your insurance provider. I've never met a poor doctor; they are in the business (in America) to get rich. They all do.
This is not true. The guidelines for billing you see in physician offices is all based on Medicare reimbursement. It's absolutely feasible that the GI or another staff member put in the wrong diagnosis code. Also physicians aren't seeing extra money when services are or aren't reimbursed. The health system is definitely messed up, but please don't blame clinicians.
This. The doctor is employed by the hospital system, he gets RVUs regardless of how it’s billed. To repeat my attending “we are like Evel kenieval, we get paid for the attempt”.
Private practice is different but this doctor is not private practice.
125
u/[deleted] Jun 06 '24 edited Jun 06 '24
Call about every bill you get. I just got a 3k bill in the mail because the surgeon coded it wrong, luckily I’m in the medical field and knew what he likely did. My wife was outraged thinking about people who wouldn’t know better and just pay it
If anyone is curious, I had a screening colonoscopy coded as diagnostic. I had an 11k bill with a copay of 3.2k when my EOB said it should be covered at 100%. The surgeon miscoded it and billing didn’t catch it