The Patient as a Billing Opportunity
Imagine going in for a free medical screening and then being hit with a big bill. It's happening a lot these days.
Company health plans increasingly are offering to pay the full cost of preventive services such as physicals, colonoscopies and mammograms to help employees stay healthy. But some patients then find they owe money for such screenings, sometimes hundreds or thousands of dollars.
So, what can go wrong? (1) The doctor's office miscodes the service. (2) Something happens, say, during a preventive exam which allows the doctor to code the episode as another service. For example, the patient mentions he has allergies or some other problem and the session gets coded as a treatment rather than a physical. (3) Or, during the exams:
Doctors sometimes order more views of suspicious masses they spot as they are doing a screening mammogram. This then gets billed as a diagnostic mammogram, which deals with existing symptoms, rather than a screening, which is for people without any specific signs of risk. For patients, that shift could mean new fees.
Warning: Once it gets coded wrong, it's like pulling teeth to get it fixed.
You got it right in the lead. The patient is an excuse for billing. And once the billing starts, things naturally get coded in a way tha maximizes reimbursement revenue.
I’ve had this happen. If you are seeing the doctor for a “free” annual physical (i.e., once a year check-up covered by your insurance) and you bring up allergies or headaches then it becomes a diagnostic visit. And, boom, you’re billed.
Which begs the question, how is it preventative to get an annual physical if you can’t discuss any potential problems?
Catch-22 in health care, again.