In the past 20 years, Ive seen so many questions asked here, elsewhere on the internet and at conferences I attend. A common question is:
The patient came in on XXXXX, we did YYYYY, ZZZZZ and the patient came in the next day and we did PPPPPP. Can I just bill TTTTTTT? Letters replace codes listed. Im saying all of this so that YOU don't forget that eventually all of what you do will get to the patient and one day that patient will be YOU! Its easy to forget where this huge snowball will ultimately end.
As an example, Im fighting 4 medical bills at the moment, all are being billed to me and the cost is more than I make in 2 months. One doctor is billing a 99244 for a simple office visit, the hospital is billing for labs and pharmaceuticals (more than a patient would take in a year), an outside lab is billing for the same identical labs that the hospital is billing and a third outside lab is doing the same. All bills are coming from the same identical doctor. Yes, that same doctor is billing a consult and labs because it looks like he is the owner of both labs. The hospital lists the doctor as the provider who performed the labs at the hospital and prescribed all the drugs. If you think all of this sounds confusing, you should be on the other side of the screen. Going to the mailbox is an adventure where there are bills, all saying, "PAY THIS IN 20 DAYS OR WE WILL BE FORCED TO SEND YOU TO COLLECTIONS!" Ive requested the medical records, itemized medical bills, and test results. So far no response other than the hospital says to contact the doctor, the labs also say contact the doctor and the doctor calls to say come in for a an office visit so we can talk, that's after he sent a letter of termination.
I have the training, certification and experience to question these bills, but your patient doesn't. What you do not only goes to an unfeeling, no emotion computer inside the deepest depths of an insurance company building, you will eventually send it to the patient and one day that patient will be you. If you were the patient what would you do if another biller does all of this to you? Those that sent me the medical record have been written that their codes XXXX, YYYYY, ZZZZZ, and TTTTT are all wrong. When Ive written back to show them that they are wrong, their coder is calling me, Mr. Verno, I need to explain why I coded it this way! Ive referred her to my malpractice lawyer and she can explain why in front of a judge and jury. My insurance company has already demanded the return of the payment they sent. Why did my insurance company do this? Simple, I showed them, based on the medical record documentation, CPT and ICD-9 guidelines, that the coding and billing was wrong. Just to let you know, Im not all mean and nasty, I have paid those bills that were correct. If you think Im mean and nasty, Im a novice compared to some patients you will meet. Ive taken those phone calls, read their letters and faced their attorneys. They can give lessons on being mean and nasty when getting a medical bill. As Ive said for years, just because you sent a claim and a check came in today from the insurance company, doesn't mean that what you did was correct and you can keep doing it. At some point, the house of cards will fall and the insurance company or a government agency will be knocking on your door or come to you in your mailbox. That $250 check you got can turn into your doctor writing a $3,000,000 check or worse. We just had a hospital write a $22,000,000 check for fraud and another is under investigation as well. So, just remember, at some point, you know what rolls down hill and remember that at some point that claim for XXXX, YYYYY, ZZZZZ and TTTTT will come to YOU as a patient!