WhyYouShouldCare: Major Changes in Medical Billing

newziesuzie · ‎02-21-2014

Interesting long article.
I'm posting just part of it.
I didn't know about this but it's something to be aware
of imho.

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http://www.scientificamerican.com/article/why-you-should-care-about-the-new-major-changes-in-medical...

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"It was only about 10 minutes into the game when I fell on the soccer pitch this summer and tore a ligament in my knee. My subsequent trip to the hospital garnered me a specific diagnostic code that went to my insurance company.

My insurer was then able to see why I sought care and billed accordingly. Despite significant upgrades in medical knowledge and care, the same thing would have happened a decade ago.

Those codes have remained largely unchanged for more than 30 years. But soon a big change to that collection of numbers and letters may be making a splash—and should bode well for consumers.

Come October 1 a code update will go into effect that will take the current 19,000 diagnostic and procedure codes and catapult that number to 142,000. The transition promises to offer greater granularity to why we seek care.

It gets wonky, but with the change researchers that deal in health data might gain more insight into what types of care get good results.

That know-how could then trickle down into better care for you.

Soon, instead of a code that simply indicates “torn anterior cruciate ligament” there will be separate codes that directly correspond to whether I tore the ACL in my right knee versus my left. Was it my first visit for care for this injury? The new coding system will cover that, too. Under the new system one code will indicate I tore my left ACL and this was my first visit for care.

That larger compendium of choices will provide greater specificity for my doctor’s future reference and also for insurers trying to suss out whether my care was necessary.

Yet one of the most significant aspects of this change continues to go largely ignored by medical workers bracing for rejected insurance claims and frustrations next month:

More detailed medical billing codes could eventually improve your health care.

Those new codes could provide a clearer picture of why individuals seek care and which health problems are growing or contracting in communities —helping inform what health issues should be researched and improved."

At the same time, some clinicians anticipate serious headaches as insurance companies and medical providers adjust to the new system—called the International Classification of Diseases (ICD-10). It is dizzyingly complex."

"Next month, complications at rollout are expected to match the scale of concerns about Y2K, according to Lisa Iezzoni, director of the Mongan Institute for Health Policy at Massachusetts General Hospital."

"For researchers, the new system will offer the difference between “knowing there are apples in the supermarket and if there are Granny Smith apples versus McIntosh apples,” Gordon says. Some medical examples: the new codes will specify what trimester of pregnancy a patient is in when she seeks care. When it comes to orthopedics there is also more detail about which particular bones or tendons are affected."

"Will better codes eventually lead to better health? That’s what researchers are counting on."

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SaRina · ‎04-17-2015

Thanks for posting this. I personally think it's important to have a more specific medical coding system and as consumers, we should keep tabs on how we are being billed should anything seem out of order.

A few months ago I was charged an additional co-pay via mail after I had paid my office exam co-pay at the office. I called the Billing Manager and asked what the second co-pay was for. She gave me some b-s response and I chose not to continue discussion with her because she was a B. When I hung up, I googled the medical code (Note: This took a little detective work as medical codes are not readily available to the general public) and discovered it was for a further specialist. I just had my annual routine exam.

Called back the Billing Manager and she wasn't hearing it. Brought it to the doc's attention and the additional co-pay was deleted.

I have since found another physician because I don't need to deal with this type of person and situation in the future. I told my doc why I was leaving.

Hopefully, more specific medical codes will make the patient's picture much clearer.

KathyPet · ‎03-09-2010

.Best be careful what you wish for. All it takes in the Medicare system is a one digit error in entering one of these code numbers to descend into Medicare hell. A coding error can cause a claim that should be paid to not be approved and believe me tracking the error down and getting it corrected is very difficult and sends the Medicare system into a tailspin. Patients and their families do not have access to these numbers and thus are not even aware that a claim was miscoded and thus denied. The addition of these codes will substantially increase the possibility of errors being made. Welcome to the hellish world of Medicare.

BlingQueen022 · ‎09-23-2012

@SaRina wrote:
Thanks for posting this. I personally think it's important to have a more specific medical coding system and as consumers, we should keep tabs on how we are being billed should anything seem out of order.

A few months ago I was charged an additional co-pay via mail after I had paid my office exam co-pay at the office. I called the Billing Manager and asked what the second co-pay was for. She gave me some b-s response and I chose not to continue discussion with her because she was a B. When I hung up, I googled the medical code (Note: This took a little detective work as medical codes are not readily available to the general public) and discovered it was for a further specialist. I just had my annual routine exam.

Called back the Billing Manager and she wasn't hearing it. Brought it to the doc's attention and the additional co-pay was deleted.

I have since found another physician because I don't need to deal with this type of person and situation in the future. I told my doc why I was leaving.

Hopefully, more specific medical codes will make the patient's picture much clearer.

I respectively disagree with everything you just said here. I work for a Physician and I do his Medical Billing and handle his insurance problems in my office. When a patient is seen the codes are listed and they are explained on what they are. It's not hard to follow. Also, when you have a problem the patient always calls the office for an explanation of benefits. Why is that? Don't you receive an Explanation of Benefits in the mail? Most patients don't even read them. They also list the codes and the explanations. They even have a colum on what the patient owes the provider. The patient would rather call my office and interrupt my busy day yelling and screaming about their bill. Most patients won't even pay their deductibles. It amazes me that a patient that doesn't understand their bill won't call their insurance company to inquire why they owe the doctor. It's your policy call your insurance company and they will explain it to you. I'm so happy this is the last winter I'm working for a doctor's office. I have to add that kudos to the insurance companies that if you don't pay your bill they doctor can turn you into the insurance company for not living up to your contract with them. The insurance company cancel your policy for that. Next time you have a problem with any bill you get from a doctor, please call your insurance company, they will explain it to you. As I said, they do list the codes and the explanations even when you leave the office the codes are listed along with the explanations. I haven't left a doctor's office yet without seeing that on the form they give you.

One thing a patient has to remember, a Medical Receptionist or billing manager only submits the claim the doctor writes up. They are not your insurance company.

terrier3 · ‎03-10-2010

@KathyPet wrote:
.Best be careful what you wish for. All it takes in the Medicare system is a one digit error in entering one of these code numbers to descend into Medicare hell. A coding error can cause a claim that should be paid to not be approved and believe me tracking the error down and getting it corrected is very difficult and sends the Medicare system into a tailspin. Patients and their families do not have access to these numbers and thus are not even aware that a claim was miscoded and thus denied. The addition of these codes will substantially increase the possibility of errors being made. Welcome to the hellish world of Medicare.

Hellish?The general public prefers Medicare over any other form of insurance and polls show satisfaction.

Miscoding has more to do with providers than it does with the insurer.

151949 · ‎03-09-2010

When I have had problems with my doctor bills , in my experience, I call the insurance company and invariably find the mistake has been made at the doctor's office. They wrote down the incorrect code. I then have to call the doctor's office biller and invariably, they give me a hard time, insisting the mistake was not them.

Bird mama · ‎03-12-2010

Yea, ICD-10 is so radically different than ICD-9 I barely recognize it. I've been in health insurance for nearly 35 years and the new stuff looks Greek to me.

There are many elements: wind, fire, water
But none quite like the element of surprise

SaRina · ‎04-17-2015

@BlingQueen022 wrote:
@SaRina wrote:
Thanks for posting this. I personally think it's important to have a more specific medical coding system and as consumers, we should keep tabs on how we are being billed should anything seem out of order.

A few months ago I was charged an additional co-pay via mail after I had paid my office exam co-pay at the office. I called the Billing Manager and asked what the second co-pay was for. She gave me some b-s response and I chose not to continue discussion with her because she was a B. When I hung up, I googled the medical code (Note: This took a little detective work as medical codes are not readily available to the general public) and discovered it was for a further specialist. I just had my annual routine exam.

Called back the Billing Manager and she wasn't hearing it. Brought it to the doc's attention and the additional co-pay was deleted.

I have since found another physician because I don't need to deal with this type of person and situation in the future. I told my doc why I was leaving.

Hopefully, more specific medical codes will make the patient's picture much clearer.
I respectively disagree with everything you just said here. I work for a Physician and I do his Medical Billing and handle his insurance problems in my office. When a patient is seen the codes are listed and they are explained on what they are. It's not hard to follow. Also, when you have a problem the patient always calls the office for an explanation of benefits. Why is that? Don't you receive an Explanation of Benefits in the mail? Most patients don't even read them. They also list the codes and the explanations. They even have a colum on what the patient owes the provider. The patient would rather call my office and interrupt my busy day yelling and screaming about their bill. Most patients won't even pay their deductibles. It amazes me that a patient that doesn't understand their bill won't call their insurance company to inquire why they owe the doctor. It's your policy call your insurance company and they will explain it to you. I'm so happy this is the last winter I'm working for a doctor's office. I have to add that kudos to the insurance companies that if you don't pay your bill they doctor can turn you into the insurance company for not living up to your contract with them. The insurance company cancel your policy for that. Next time you have a problem with any bill you get from a doctor, please call your insurance company, they will explain it to you. As I said, they do list the codes and the explanations even when you leave the office the codes are listed along with the explanations. I haven't left a doctor's office yet without seeing that on the form they give you.

One thing a patient has to remember, a Medical Receptionist or billing manager only submits the claim the doctor writes up. They are not your insurance company.

I empathize with your experience BQ. I have been in Customer Service as well as worked in hospitals and doc's offices. I fully understand the hassles billing personnel have to deal with.

I was clearly mis-billed as I only had a routine annual exam, which did not merit a second code no matter what the code represented.

When I received the additional bill in the mail, it said to call the Billing Rep if any questions, with a phone number. That is the FIRST step. Since the BR gave me a completely inane response regarding the code (thinking she would get rid of me, I assume), I chose to investigate on my own. (Please note, my EOB came weeks after I received the bill, but it only showed a vague explanation next to the code.)

I found the code on-line and THEN called my insurance co. to discuss. They told me I have to "settle it with the doctor's office -- they bill what they are sent." This led me to bringing up the erroneous charge directly with the doc, who acknowledged that in 20 years I had never had anything more than a routine annual exam. Thus, the charge was deleted.

Snoopp · ‎02-02-2015

@BlingQueen022 wrote:
@SaRina wrote:
Thanks for posting this. I personally think it's important to have a more specific medical coding system and as consumers, we should keep tabs on how we are being billed should anything seem out of order.

A few months ago I was charged an additional co-pay via mail after I had paid my office exam co-pay at the office. I called the Billing Manager and asked what the second co-pay was for. She gave me some b-s response and I chose not to continue discussion with her because she was a B. When I hung up, I googled the medical code (Note: This took a little detective work as medical codes are not readily available to the general public) and discovered it was for a further specialist. I just had my annual routine exam.

Called back the Billing Manager and she wasn't hearing it. Brought it to the doc's attention and the additional co-pay was deleted.

I have since found another physician because I don't need to deal with this type of person and situation in the future. I told my doc why I was leaving.

Hopefully, more specific medical codes will make the patient's picture much clearer.
I respectively disagree with everything you just said here. I work for a Physician and I do his Medical Billing and handle his insurance problems in my office. When a patient is seen the codes are listed and they are explained on what they are. It's not hard to follow. Also, when you have a problem the patient always calls the office for an explanation of benefits. Why is that? Don't you receive an Explanation of Benefits in the mail? Most patients don't even read them. They also list the codes and the explanations. They even have a colum on what the patient owes the provider. The patient would rather call my office and interrupt my busy day yelling and screaming about their bill. Most patients won't even pay their deductibles. It amazes me that a patient that doesn't understand their bill won't call their insurance company to inquire why they owe the doctor. It's your policy call your insurance company and they will explain it to you. I'm so happy this is the last winter I'm working for a doctor's office. I have to add that kudos to the insurance companies that if you don't pay your bill they doctor can turn you into the insurance company for not living up to your contract with them. The insurance company cancel your policy for that. Next time you have a problem with any bill you get from a doctor, please call your insurance company, they will explain it to you. As I said, they do list the codes and the explanations even when you leave the office the codes are listed along with the explanations. I haven't left a doctor's office yet without seeing that on the form they give you.

One thing a patient has to remember, a Medical Receptionist or billing manager only submits the claim the doctor writes up. They are not your insurance company.

I can think of times where my insurance company customer service rep has bounced me back to the doctor's office. The last thing I want to hear from my doctor's office is that they don't have time to take my call and help get an issue straightened out. Especially when the office was the one who coded a visit incorrectly. So it's not always the fault of the patient.