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Honored Contributor
Posts: 18,324
Registered: ‎04-28-2010

Re: WhyYouShouldCare: Major Changes in Medical Billing

[ Edited ]

A good idea that I've been suggesting to folks around here for many years is to mark on your calendar your doc's appt., lab work, x-rays, etc.,what it was for, and your co-pay that you paid.  Hang one of those calendars that have large squares for each day.  THEN, when you receive your periodic summary, make sure that what is listed is the exact same as what you marked on your calendar.  Also, save that calender (don't toss it out on Dec 31), and you can go through it for that year's income tax deductions!  It's so much easier to have it marked on the calendar, in order.  Easy-peasy!    Don't forget to include meds.  Just in case it's a med that you are no longer taking, yet it was billed by mistake or they forgot to electronically cancel that med.

'More or less', 'Right or wrong', 'In general', and 'Just thinking out loud ' (as usual).
Respected Contributor
Posts: 3,358
Registered: ‎02-21-2014

Re: WhyYouShouldCare: Major Changes in Medical Billing

Great idea @ROMARY!

 


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Respected Contributor
Posts: 2,315
Registered: ‎03-09-2010

Re: WhyYouShouldCare: Major Changes in Medical Billing

This has been in the works for several years and has been put off many times as to the date it goes into effect.  This causes MAJOR costs to physicians offices and I dont mean in payments for services.  Im talking about employee training and software. Not to mention training for claims representatives at the insurance companies and Medicare itself.

Trusted Contributor
Posts: 1,919
Registered: ‎08-31-2010

Re: WhyYouShouldCare: Major Changes in Medical Billing


@terrier3 wrote:

@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.


Actually, people prefer private plans, and Medicare satisfaction depends on the plans you're offered.  My dad has great options because he was a teacher, but if he wanted to spend less than $400 a month, Medicare wouldn't be that grand.  

 

 

Read it! New England Journal of Medicine—May 21, 2020
Universal Masking in Hospitals in the Covid-19 Era

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Esteemed Contributor
Posts: 5,660
Registered: ‎03-09-2010

Re: WhyYouShouldCare: Major Changes in Medical Billing

I warned about this in a earlier post and sure enough I have already run into problems with the new codes.  My husband just went through his first chemo session for a brain lymphoma here at UVA.  When We went to the cancer center they told us that the DR had ordered meds for him to take when he is released and they were at the cancer center pharmacy to be picked up.  I went over today to get them and could not get them because they were ordered on 9/29 and approved by Medicare with the old codes.  Now they have to re billed  under a new code which evidently Medicare is not approving.  So I have to return tomorrow and see if it has been resolved so I can pick them up.  Now, I can return tomorrow because he is still in the hospital but suppose we were ready to go home and I couldn't get his medications to take with me???  I warned that this would happen and others went on and on about how wonderful these changes would be.

Esteemed Contributor
Posts: 5,291
Registered: ‎06-15-2015

Re: WhyYouShouldCare: Major Changes in Medical Billing



newziesuzie wrote:
My wife worked as a Medical and Dental Claims Analyst for over 30 years before retiring last January. The number of wrong codes she found on claims sent in by doctors and/or there staffs were astounding.
Not only that, we have found countless wrong codes on our own Medical EOB's, and had to contact the insurance companies and the doctors offices to get them changed and recharged. Had my wife not known the codes, which most people do not?
In many medical and dental offices the staff is barely paid minimum wage, and as the old saying goes, "you get what you pay for". I don't blame the individuals doing the work, I place the blame squarely where it belongs. That is the doctors practice not allowing the proper amount of time and training and also not having a certain number of "Claims" being checked for accuracy when it comes to the coding on them.

 

 

 

 

 

hckynut(john)
Super Contributor
Posts: 354
Registered: ‎07-11-2012

Re: WhyYouShouldCare: Major Changes in Medical Billing

I'm a NP and I can tell you, these codes are a pain! Large institutions have coders, but we do our own. I had to code bug bites today. Probably 50 choices! All the changes have slowed down and frozen my computer. 

Honored Contributor
Posts: 12,845
Registered: ‎03-09-2010

Re: WhyYouShouldCare: Major Changes in Medical Billing


@tansy wrote:

@terrier3 wrote:

@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.


*****

 

I can hardly wait to be 65 and tossed into Medicare hell😀


Actually I can't wait to be a few years older and get medicare.  It will certainly be cheaper than what we pay now. Dh was forced into early retirment and since we don't get medicare (DH has one more year) and are both over 60 our health insurance is almost $1,000.00 a month with a $10,000.  deductible.  I just try to avoid going and hope for the best right now.

Honored Contributor
Posts: 14,092
Registered: ‎01-02-2011

Re: WhyYouShouldCare: Major Changes in Medical Billing

You don't speak for anyone I know, @Blahblahvampemer.

 

I am happy to have insurance with my preconditions.  My husband's on Medicare with no complaints whatsoever.  

Respected Contributor
Posts: 3,816
Registered: ‎03-24-2010

Re: WhyYouShouldCare: Major Changes in Medical Billing


@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.  


 

 

They call you, too? Ugh! I've just retired from 30 years as a medical claim adjuster and we get the same ridiculous calls. No, they do not read Explanation of Benefits or know what a deductible is. I'm sorry, a $300 deductible isn't BAD and why do they yell at us. It's disgusting .

 

Diagnosis codes have been removed from our EOB's because of privacy issues.  You sound like you are a very good biller and we appreciate a nice clean bill with no errors so we can pay it. Smiley Happy. But folks must take responsibility for themselves ! 90% of the calls we receive are on the EOB's we have sent them.  I swear they throw them out.