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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: 1) by nitehawk214 on Tuesday May 05 2015, @06:48PM
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
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.