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from the are-the-codes-secret-are-they-safe? dept.
Elisabeth Rosenthal writes in the NYT that she has spent the past six months trying to figure out a medical bill for $225 that includes "Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others" and she really doesn't want to pay it until she understands what it’s for. "At first, I left messages on the lab’s billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: “I’m sorry, this is what I’m told, and I don’t want to lose my job.”" Bills variously use CPT, HCPCS or ICD-9 codes. Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all. Heather Pearce of Seattle told me how she’d recently received a $45,000 hospital bill with the explanation “miscellaneous.”
So what's the problem? “Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that,” says Mark Hall. “We’ve not seen a lot of pressure to standardize medical billing, but there’s certainly a need.” Hospitals and medical clinics say that detailed bills are simply too complicated for patients and that they provide the information required by insurers but with rising copays and deductibles, patients are shouldering an increasing burden. One recent study found that up to 90 percent of hospital bills contain errors and an audit by Equifax found that hospital bills that totaled more than $10,000 contained an average error of $1,300. “There are no industry standards with regards to what information a patient should receive regarding their bill,” says Cyndee Weston, executive director of the American Medical Billing Association. “The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry.”
(Score: 5, Informative) by Dunbal on Tuesday May 05 2015, @05:21PM
As someone who suffers from chronic heart disease I've been hospitalized too many times to count. As a physician, I always insist in reading my hospital bills line by line before paying. It is common (as in, almost every single time I've had a bill) to be billed for - things that weren't actually used on my, tests that weren't actually done to me, billed for medications I did not receive, billed for entire boxes of medication when I received perhaps one pill (out of 28), etc. PLEASE GOD always always ALWAYS check your bills. If you have doubts, then the key is your patient file. Nurses cannot dispense anything that's not written in the file. Labs cannot run any tests not indicated in the file. If you're in doubt and the hospital swears you received it - ok, show me in the file where it says it was indicated. If it's not in the file it does not exist, was never given to you (even if it was), and you cannot be billed for it.
Now before you start jumping down a hospital's throat - often these errors happen because of lack of staff training, staff laziness,etc and not actual malice. The wrong codes are used when submitting the info to the billing software, or the right codes are applied to the wrong patient account, etc. While I am sure there can be places where these mistakes are "encouraged" don't instantly assume that the hospital is out to give everyone the shaft. But do, however, be very very vigilant.
Now if the hospital won't even discuss their cryptic, arcane billing system with you then you have every right to withhold payment until they explain to your satisfaction what exactly they are charging you for. You will get a much faster response if you refuse to pay until you get your answers than you would if you pay and then hope for clarification. If you pay, they already have your money and have no rush to make you happy until your lawyer starts calling them. I know it's a pain, but this must be done BEFORE you leave the hospital when checking out.
(Score: 3, Interesting) by tibman on Tuesday May 05 2015, @05:45PM
Sorry about your illness. I have had similar billing issues but not with false line items. They charge 5$ for every set of gloves used! One-time a nurse offered a pain-pill while i waited for surgery (for a new metal plate). That pill was itemized at 120$. A fitted wrist wrap was 90$ with 130$ adjustment/sizing. 130$ to adjust some velcro!
SN won't survive on lurkers alone. Write comments.
(Score: 4, Informative) by Dunbal on Tuesday May 05 2015, @05:55PM
Yeah I know. Sometimes it's justified - like when an item forms part of a kit and they have to open the whole kit and discard/re-sterilize what they don't use even if only a small part of the kit is used. But the $200 aspirin is a no no and should be brought up before the appropriate consumer protection organization(s).
(Score: 4, Funny) by Alfred on Tuesday May 05 2015, @06:22PM
I want that job. I could adjust like 20 an hour.
More importantly I'm glad you caught the rip off (not a Velcro joke).
(Score: 2, Funny) by nitehawk214 on Tuesday May 05 2015, @06:33PM
Only better job would be professional bubble wrap popper. I would kick ass at that.
"Don't you ever miss the days when you used to be nostalgic?" -Loiosh
(Score: 2) by Adamsjas on Tuesday May 05 2015, @07:34PM
Not sure he did catch the rip off in time to stop it though. Most people have insurance, and insurance just pays it.
People make a big deal about these seemingly high charges. But if they had to pay the cost of the employee, (Nurse, or office-flunky as the case may be) for the time it took to deal with their admission and treatment, as well as the rental of that portion of computer equipment and the time to enter the data to print the wrist band, they would probably be more incensed.
Are the charges actuarially determined? Maybe, maybe not. The old joke was that there were Yachts to pay for. But that hasn't been true for a long time. http://www.wsj.com/articles/the-u-s-s-ailing-medical-system-a-doctors-perspective-1409325361 [wsj.com]
(Score: 2) by tathra on Tuesday May 05 2015, @08:35PM
there's still yachts to pay for, its just that now they're owned by the middlemen who do nothing but jack up prices to suck more and more money out of the system.
(Score: 1, Insightful) by Anonymous Coward on Tuesday May 05 2015, @06:15PM
Now before you start jumping down a hospital's throat - often these errors happen because of lack of staff training, staff laziness,etc and not actual malice.
That malice comes in at the higher level where management decides that they don't need to invest in correcting those problems. It is sort of a malignant neglect - since the errors are generally in their favor, they get more money by leaving things the way they are and forcing patients to choose between a long drawn out fight for an honest bill or just giving up because they don't have the time and energy. Cell phone and cable companies are notorious for a similar sort of behavior simply because they can get away with it since they face so little competition.
(Score: 0) by Anonymous Coward on Tuesday May 05 2015, @06:42PM
It goes further back than that. This sort of error happens all the time because it is BUILT IN.
I used to write software that did this. Ask your doctor about standard procedures. Basically you come in for X. The computer then decides you need Y and Z (because standard...). Even though you may never do Y and Z. It just automatically does it. I would bring it up in our daily meetings while making the software that seemed 'shady' I was told 'its what our customers want'.
This doctor knows the real system. Which is not in any way the same system as the billing system. Which is why he asks for that chart as the chart knows all. The doctors and nurses are doing the right thing. The front office though is there to get money.
I called it insurance chicken. Basically submit all the data. Hope it gets paid. If not flip it to the guarantor. If that doesnt work flip it to collections or just tax deduct it. No one cares because 'the insurance pays for it'. We even passed huge 'healthcare bills' that are nothing more than mandated insurance.
(Score: 2, Informative) by Anonymous Coward on Tuesday May 05 2015, @06:47PM
And as a physician I'd expect you have the resources to hire a good lawyer when you're threatened with being sent to a collection agency, and also the ability to comprehend the language of the patient notes.
Most people don't, for either of the above. And so what do you advise the minimum-wageish earner to do when the practice says, "Pay up or be sent to a collection agency...."
I've never caught a billing mistake, even though I can parse ICD-9 and CPT. I've seen systematic upcharging on some of my E&M charges, but you can't fight that. (10 minutes of physician time for a routine item translating to a level 4 visit, for example.)
That said, for the article's submitter, for Elisabeth Rosenthal and from https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx [cms.gov] :
87481 Candida dna amp probe
87491 Chylmd trach dna amp probe
87798 Detect agent nos dna amp
No, I'm not making those up, and they may have been routine screenings rather than diagnostic.... Hope so, anyway. But anyway, that CMS site will let you plug in the five-digit CPT codes and get a description of what the code is along with the Medicare allowable amount for any Medicare jurisdiction and/or the national payment amount for Medicare. Even Googling "CPT 87481" will give you enough information on the search results page.... though going beyond and clicking any links requires good knowing what you're doing against a virus trap.
As to the other, three digit codes, those are almost certainly lab index numbers from whatever laboratory performed the tests - that would take talking to whomever did the actual testing.
Final piece of advice: Do NOT argue with the first line/front line billing or reception people. They almost certainly have not been given authorization to discuss the matter to you. Speak to a billing supervisor and/or clinical staff to get them to translate the codes, and to communicate with you about your treatment and the codes used. There will be people to talk to you, but thanks to HIPAA/ARRA/HITECH and $50,000 fines for noncompliance you can be damn sure nobody who isn't authorized to give you the information should be talking to you about it.
(Score: 0) by Anonymous Coward on Tuesday May 05 2015, @07:12PM
> 87491 Chylmd trach dna amp probe
A little penicillin will clear that up.
(Score: 2) by Dunbal on Tuesday May 05 2015, @07:59PM
azithromycin for chlamydia, actually :)
(Score: 0) by Anonymous Coward on Tuesday May 05 2015, @08:25PM
I'd googled the codes too. This isn't indecipherable, but it's inconvenient, which means it's a user interface problem, and I think that's what the author of the article is getting at. Really, how hard would it be for medical billers to pull a brief, simple English description of each CPT code from a table and print them on the bill? The codes exist to provide a standardized ID, and ID's are good for table lookups, and table lookups are good for providing text descriptions. There's absolutely no reason why medical billing shouldn't be able to print "Chlamydia (sexually transmitted disease) test using amplified probe technique" instead of the CPT.
It's kind of like course numbers in college. There's no point now to having ENG1131 written anywhere, since the databases that run school records ought to be able to print a more descriptive title. And that doesn't mean a thirty-character-max all-upper-case abbreviated description like BAS DB KNOW AND SKLS, but a real, human-friendly title, like "Basic Database Knowledge and Skills."
(Score: 1) by nethead on Wednesday May 06 2015, @04:08AM
Of course it's going to be BAS DB KNOW AND SKLS. You have to take ENG1231 ADV DB KNOW AND SKLS to get the computer to output "Basic Database Knowledge and Skills."
How did my SN UID end up over 3 times my /. UID?
(Score: 2) by GreatAuntAnesthesia on Tuesday May 05 2015, @07:33PM
Withholding payment until you get an explanation sound like good advice and its what I'd do, but I can easily imagine a situation where someone is disputing a bill, then has to go back into the same hospital for further treatment, and then the hospital decides to withhold treatment until the bill is paid.
Is this the bit where I smugly announce how glad I am not to have to put up with this kind of shit on the nhs?
(Score: 1) by mathdan on Tuesday May 05 2015, @10:30PM
My wife is always checking our bills, and she catches many overbilling errors. When our second child was born, she caught several outright mistakes along with a few hundred dollars worth of billing that we weren't sure should be there. Almost a year later, after just trying to get the items *confirmed* (not even disputing them yet) they sent our bill to collections (without warning us). We'd have kept fighting it if we weren't trying to refinance our mortgage and didn't want the ding on our credit report to hurt us.
Incidentally, we have also lived in Canada, and using that medical system was so much better in terms of saving time, money, and frustration. We have never gotten medical treatment in the States that was qualitatively so much better as to justify the high prices, constant billing errors, and minefields of insurance "gotchas."