Quote:
Originally Posted by drducat
So doctors are complicit in putting down diagnosis of things such as 4th stage kidney failure if your blood test shows increase of BUN value which can be off due to dehydration etc etc
Those can be a one off report and means nothing unless it continues...if your chart shows a list of problems that you are not being treated for or have no knowledge of them you could be a victim.
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If that's what happened, then yeah doctors would be complicit. But that's not what happened. Doctors don't do billing, they don't input billing codes. I've explained this before...I'll try it again.
Let's say you have a regular annual checkup, and the doctor asks how you've been feeling. You say you're fine, except your bunion's been hurting lately. The doctor says he can give you a referral to a podiatrist if you want, you say thanks, but my bunion pads are still working, it's probably just the humidity lately.
The doctor inputs the code for the annual physical. He inputs the code for the discussion about your bunion (because it's important to know that there's a history of it, in case you do need a referral, he can tell the podiatrist you've had this problem since at least xyz date and are treating it with bunion pads).
He sends the documentation through the system, and now it's the billing department's turn to deal with it.
The billing department puts in the billing code for the annual physical.
They also put a billing code for a podiatry consultation, because record-keeping is important.
You only pay your co-pay, which is probably 0 since it was all part of your physical exam.
But the insurance company sees the code for the podiatry consultation, and sends your doctor's office a check for $197 instead of $143, because an annual physical plus podiatry consultation pays out $197.
But here's the thing - there are 7 different billing codes that COULD be input, for a brief moment's worth of discussion with a doctor during an annual physical about your bunion. The one your doctor's billing department chose was the wrong one. The one they were supposed to choose should have resulted in a $146 payment, not a $197 payment (and not the bare-bones $143 payment either).
But this is the billing code they've been using for years whenever any of the thousands of patients they have discusses a bunion during an annual physical, and up until now, no one's said "hey wait a minute - why is everyone using this code? Surely some patients have different bunion conversations during their annual physicals?"
So that's essentially what happened.