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posted by CoolHand on Tuesday May 05 2015, @05:12PM   Printer-friendly
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.”

 
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  • (Score: 3, Informative) by CoolHand on Tuesday May 05 2015, @05:31PM

    by CoolHand (438) on Tuesday May 05 2015, @05:31PM (#179167) Journal

    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.”

    WRONG WRONG WRONG!
    A patient always has a right to their own data [healthit.gov]! (except in very small edge cases):

    You have the right to receive copies of your health information from your doctor and from other providers, such as physical therapists and social workers. If your health care provider keeps your records electronically, you have a right to receive them in either electronic or paper form. Depending on your doctor's or hospital's policies, you may have to make requests for health information in writing, and you may be asked to pay a small fee to cover your doctor's costs for furnishing you with the information. Many health care providers — particularly those still using paper-based systems — may not have all of your records available immediately, so it might take them a while to fulfill your request. Finally, in some limited circumstances, your doctor may refuse to comply with your request. In such cases, they must supply an explanation in writing.

    --
    Anyone who is capable of getting themselves made President should on no account be allowed to do the job-Douglas Adams
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  • (Score: 2) by Alfred on Tuesday May 05 2015, @05:57PM

    by Alfred (4006) on Tuesday May 05 2015, @05:57PM (#179174) Journal
    Possible counter point, subject to discussion:

    It can be difficult to verify that the seemingly random person on the phone is actually the person they say they are. We don't know the context of the story and anyone can say the words to get the effect of "After I pointed out that I was the patient in question." For a phone based interaction I expect the authentication to be deeper than what one could find on a bill stolen from my mailbox.

    Also possibly applicable here, I believe that there certain types of things they cannot discuss over the phone. Which may be policy of the individual institution or law, I'm not sure which.

    I fully expect them to protect my information from unauthenticated requests. I also expect that all the information is mine and I get to have it all (I am not an edge case).
    • (Score: 1, Insightful) by Anonymous Coward on Tuesday May 05 2015, @06:19PM

      by Anonymous Coward on Tuesday May 05 2015, @06:19PM (#179186)

      > It can be difficult to verify that the seemingly random person on the phone is actually the person they say they are.

      Unless the code definitions are classified secrets, only available to people with security clearances, that does not matter.
      The person on the phone tells you the code number and you tell them the code definition - completely independent of any specific bill.

    • (Score: 1) by nitehawk214 on Tuesday May 05 2015, @06:48PM

      by nitehawk214 (1304) on Tuesday May 05 2015, @06:48PM (#179200)

      If only there was a law [hhs.gov] that said the provider must give you the data and how they must verify identity. Obviously giving info over the phone to whomever calls is wrong and illegal. Simply denying to explain because "its too hard to figure out" is also wrong and illegal.

      Though, I can understand people being confused on the process and the laws, it seems like they are intentionally confusing and vague. However the legal department of a provider absolutely knows the answer. The person on the phone in this example should be fired for refusing to do their job and escalate the issue to someone with the authority to resolve it. (The

      Additionally, you could ask the health care provider that ordered the tests. They are also obligated to explain why they ordered it and provide documentation. My guess is this is what the patient really wants to know, "Why did I spend so much money on this test?" The lab might not even know. This happens with radiology. The technician of a MRI machine literally cannot tell you what they found. Only the doctor is authorized to give a diagnosis.

      Here is where it gets fun: CPT codes are not free. You actually have to pay a cartel (the AMA) to get the code values. So if all they do is report the codes, you are fucked. I wouldn't be surprised if HIPAA was written stupidly enough to allow them to just give you this and then tell you to fuck off when the code is useless to you.

      --
      "Don't you ever miss the days when you used to be nostalgic?" -Loiosh
      • (Score: 0) by Anonymous Coward on Tuesday May 05 2015, @07:40PM

        by Anonymous Coward on Tuesday May 05 2015, @07:40PM (#179219)

        Uh, no.

        CPT codes are indeed proprietarily licensed to the AMA.

        However, they are NOT secret and you do NOT need to pay a fee personally to translate a code.

        Aside from using Google "i.e. Google 99212 and you get that it is a Level 3 office or outpatient visit, just by reading the search results," you can also go to https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx [cms.gov] and plug in any CPT code or range you'd like. The rest of the form is a little complicated (just choose anything) and it's a little arcane to understand the output, but the code and description will pop right up for you.

  • (Score: 0) by Anonymous Coward on Tuesday May 05 2015, @06:13PM

    by Anonymous Coward on Tuesday May 05 2015, @06:13PM (#179180)

    So, the answer is:

    "If this is what they tell you to say, please put me on the line with your supervisor who is telling you to say this."

    Take names, and push it up the chain until you reach someone who feels they have sufficient authority to make things right.