Here's why I think healthcare "dine & dash" is OK [Archive] - Debate Policy

View Full Version : Here's why I think healthcare "dine & dash" is OK

tailfins

09-03-2014, 11:39 AM

This guy goes to a whole lot of trouble. It's easier to make yourself judgement proof, get the treatment, don't have insurance and don't pay the bill.

http://online.wsj.com/articles/eric-michael-david-health-care-and-the-20-000-bruise-1409700173

NightTrain

09-03-2014, 11:41 AM

Looks like you need a subscription to read it.

tailfins

09-03-2014, 11:50 AM

To work around the WSJ paywall, do a Google search on "Health Care and the $20,000 Bruise", then click on the link via the Google search results.

ByEric Michael David

Sept. 2, 2014 7:22 p.m. ET
<article id="articleBody" class="module articleBody" itemprop="articleBody">As a doctor and a lawyer, I like to think I'm pretty good at navigating the health-care system. So when my wife and I found a large swollen bruise on our 3-year-old son's head more than a week after he had fallen off his scooter, I was confident we could get him a CT scan at a reasonable cost.
We live near one of the top pediatric emergency rooms in the country. The care was spectacular. My son was diagnosed with a small, 11-day-old bleed inside his head, which was healing, and insignificant.
I was proud to see the health-care system working, to see academic medicine working, and most of all to see my son run as fast as he could out of the ER two hours later.
Enlarge ImageClose (http://javascript<strong></strong>://)

http://si.wsj.net/public/resources/images/ED-AS624_EricDa_DV_20140902191458.jpghttp://si.wsj.net/public/resources/images/ED-AS624_EricDa_G_20140902191458.jpg
Getty Images/iStockphoto

Then the bill arrived, and you know where this is going: $20,000. Our insurance had already paid $17,000, and we owed $3,000 out-of-pocket. What for? Among the items listed on the printout was a $10,000 charge for a "trauma team activation." This made me want to give consumers some very simple tips on how to fight their health-care bills, so here goes:

1. Get yourself a job as a doctor or nurse. I've served on trauma teams in two of the busiest hospitals in New York City, and I know what a trauma-team activation looks like: doctors, nurses and residents running and yelling, IV lines, monitors. You know one when you see one. Nothing like that happened around my son. So I picked up the phone and told the hospital that the trauma charge was a mistake.
The billing agent explained that it was hospital protocol to call a trauma team when there is internal bleeding in a head injury. I argued, correctly, that it wasn't clinically indicated.

2. Have or gather the legal knowledge to know when you are being lied to. The hospital billing agent wasn't a physician and couldn't refute my clinical judgment, so she told me it was "county protocol" to call a trauma in such cases. This was a bluff, meant to get me off the phone by hiding behind regulations, a very effective tactic used by hospital administrators.
I called her bluff and said if she could show me the county regulation requiring a trauma team for an 11-day-old head injury, I'd happily pay my bill. She said she'd have the head of emergency services call me.

3. Have the resources to pay huge bills up front while you wait the months it takes to correct billing errors. Two weeks later, the physician head of emergency services called. He was professional, knowledgeable and in agreement that I should not have been billed for the trauma activation. He'd call the billing team to tell them so.
A week later, the hospital wrote to say that they were delighted I'd had the chance to speak with the head of emergency services, but the billing department had determined that the $10,000 charge was accurate.

4. Understand that only the billing department, not the physicians, decides what is billed. The hospital we visited is a level-one trauma center, so it will bill for a trauma activation at every possible opportunity. It's how any sane person would run such a cost-intensive business. Hospitals will always "upcode"—bill for as intensive a level of care as they can legally get away with.

5. Know where the hospital billing managers go to decide what kind of upcoding they can get away with.
Most hospital billing guidelines, whether for Medicare or private insurers, are derived from a several-thousand-page manual published by the Centers for Medicare Services called the Medicare Claims Processing Manual. You can access it online at CMS.gov (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html), although it is impenetrable. But here's a secret: There are lots of blogs out there written by the hospital coders that do the billing, and they blog about how to ensure a hospital can make their bill stand up to the payers—i.e., insurers—whose job is to negotiate the bill down.
6. Google (http://quotes.wsj.com/GOOGL) GOOGL +0.34% (http://quotes.wsj.com/GOOGL)Google Inc. Cl A (http://quotes.wsj.com/GOOGL)U.S.: Nasdaq$590.66+2.03+0.34%Sep 3, 2014 12:51 pm Volume (Delayed 15m) : 959,782 P/E Ratio 29.96Market Cap $394.32 Billion Dividend Yield N/ARev. per Employee $1,321,030<canvas height="92" width="234"></canvas>595.00592.50590.00587.5010a11a12p1p2p3p09/03/14 Sony's Smartphone Offering: Lo... (http://blogs.wsj.com/digits/2014/09/03/sonys-smartphone-offering-longer-battery-life-playstation-streaming/)09/03/14 Is Your Food Safe? Baidu's New... (http://blogs.wsj.com/chinarealtime/2014/09/03/is-your-food-safe-baidus-new-smart-chopsticks-can-tell/)09/03/14 Nokia Plans to Unfurl New Mobi... (http://online.wsj.com/articles/nokia-plans-to-unfurl-new-mobile-map-app-1409741865)More quote details and news » (http://quotes.wsj.com/GOOGL?mod=articleInlineTicker)GOOGL (http://quotes.wsj.com/GOOGL) inhttp://www.debatepolicy.com/image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAKwAAAAgCAYAAAC PQ5N7AAAAGXRFWHRTb2Z0d2FyZQBBZG9iZSBJbWFnZVJlYWR5c cllPAAAA2hpVFh0WE1MOmNvbS5hZG9iZS54bXAAAAAAADw/eHBhY2tldCBiZWdpbj0i77u/IiBpZD0iVzVNME1wQ2VoaUh6cmVTek5UY3prYzlkIj8+IDx4On htcG1ldGEgeG1sbnM6eD0iYWRvYmU6bnM6bWV0YS8iIHg6eG1w dGs9IkFkb2JlIFhNUCBDb3JlIDUuMy1jMDExIDY2LjE0NTY2MS wgMjAxMi8wMi8wNi0xNDo1NjoyNyAgICAgICAgIj4gPHJkZjpS REYgeG1sbnM6cmRmPSJodHRwOi8vd3d3LnczLm9yZy8xOTk5Lz AyLzIyLXJkZi1zeW50YXgtbnMjIj4gPHJkZjpEZXNjcmlwdGlv biByZGY6YWJvdXQ9IiIgeG1sbnM6eG1wTU09Imh0dHA6Ly9ucy 5hZG9iZS5jb20veGFwLzEuMC9tbS8iIHhtbG5zOnN0UmVmPSJo dHRwOi8vbnMuYWRvYmUuY29tL3hhcC8xLjAvc1R5cGUvUmVzb3 VyY2VSZWYjIiB4bWxuczp4bXA9Imh0dHA6Ly9ucy5hZG9iZS5j b20veGFwLzEuMC8iIHhtcE1NOk9yaWdpbmFsRG9jdW1lbnRJRD 0ieG1wLmRpZDowMDgwMTE3NDA3MjA2ODExODIyQTg2NzE2NDA3 MDUyRCIgeG1wTU06RG9jdW1lbnRJRD0ieG1wLmRpZDo5RkRFNU I4NDE0QjYxMUUzOTMzQ0M4QjgyNEMyMjcwNSIgeG1wTU06SW5z dGFuY2VJRD0ieG1wLmlpZDo5RkRFNUI4MzE0QjYxMUUzOTMzQ0 M4QjgyNEMyMjcwNSIgeG1wOkNyZWF0b3JUb29sPSJBZG9iZSBQ aG90b3Nob3AgQ1M2IChNYWNpbnRvc2gpIj4gPHhtcE1NOkRlcm l2ZWRGcm9tIHN0UmVmOmluc3RhbmNlSUQ9InhtcC5paWQ6MDE4 MDExNzQwNzIwNjgxMTgyMkFCRDlGMTk2MEE1QzIiIHN0UmVmOm RvY3VtZW50SUQ9InhtcC5kaWQ6MDA4MDExNzQwNzIwNjgxMTgy MkE4NjcxNjQwNzA1MkQiLz4gPC9yZGY6RGVzY3JpcHRpb24+ID wvcmRmOlJERj4gPC94OnhtcG1ldGE+IDw/eHBhY2tldCBlbmQ9InIiPz7PuBBXAAAEoElEQVR42uxci3GjMB AVnmuAFkgJXAchJXAl4BLsEqwSohJMCSEdnEs4WqAEn8hImc16 JQQSRk70ZjQeM1jsSk/7E3J2vV5ZQsKj4JdvB8/Pz2kU40IpW4WuCdkGj/5y4vrFo89PvL+/35ewCVHhjSCrJle3sM+Toc8XS58H9Tum7nkJamGllTTFBU9yBf SOfb3K1hDXj7LxO04aHCwXjJPZq4EVEZGvUq0e58FR7+qnhwTj IOwd+ikMZH0UF1oqYjRK30sEZH1bsFA1erX4LuD7UlyQXFETtp HWlztY2cM3iv9GT/H7weQuUJy59wgBKA+p4ZqhD+D5QRf/TgW+2diQcNDVT1kDyrpmqvE7Tx4Hz8YDnxHtDxrU8gG9RYG+dx vLI1Tc+mLglB9hpwgprWz1ja1rqwZ2iMn1JfhVCQ7UqlVEdpnc SlkuG2l02NEYyijQgobGoGRoJgir9aiIpE046Kyz9Vw9qwLXj2 DxFxNGoVWf9Yz7+4V6zLHytWFsjX0qDpGySK8vlhJ2tLK17KAl Sh6useHJIVPXk1DdmbA4McELZvx+NshVAZLA8ILSWZP11bAoTW N0MiRCc+7vF+oxh7CUPKbqy6QsknMfskjeXVxDgs40CLKzBlmQ reOmtZAzc30TT9jbhCepLGR9JD3uKovkWulqYTnotBhJCsz0AZ G1swigXR4ufwm18nvkvjplaUvw+3blCa0NpRy8MFtkMaAlzZGF OhKLPSfKTjgjx+N0NHiDOfcv1WOOhzqChWkj42JZrISV5OwkST vkLoSyrgUidjlhqbU7rIGF6QkXTy0IwdYt6uMBNNUeW2ISO0TK GumMCWvb+eGGygsPcP9SPeYQljsmrl9kkTy7kUVt+d/I4lIlgBsHo5U9oQkQM8KBAVnKxmLtcpegfQYqtQhwOxOlO2EYX OEYV1cTJZ8tEFqPVWWRJOZEcjaddI2bBvJmAch18EyCYF86s2w t7lkEHCSXCeBs3Z2ugSUsxs7xPm4h39xtvwuzb/cVKxHWNQY7JlrEC6eyFmFlfUtMArjhRpFkIKxrx/z2wak42rSIukSHb0JYkHnC2PKoiLzkua2Kg3NAWk7EtSErAx27/zZxwkYhwWhlBzDhvokQTr5qEB4UgZOthJ9IWODKP4irCOwDXHc rN4pdXWJbGF9TKCy/CYH8m+jhLIv03KQsswgLrGwIMuHk68BuNxViAN7tKwkyndHA9g GfyViYt8e20MNJFriTpch6I4t+xTUbDyFaThwwEK9yYhW4vGhs O3HQMPr1RZ9jFa4nDjLH/igdO+QdckLfKTmmdPzLbjczBvCMC5ve3oRjv1SPqWdoPVy4oI/VzJZF82/rM12tgbAtiwfjQO6RnJUlzAmV2HFkZUrPEGErPbxlgcZytzEZq MQqxmRLMPuhu15NwD7wYt4Hdstb6OEliyTrF1ky3/8lCHTMG7pPzuIv3lcGV70WCpCchHzevfWg8iIYXn7KYkrqYyHs PzAhTysG+wmRYe7/EuwikLkGZO0SWRNiJOwYAlxVOyMXdWXzjzgnJMImJCTCJiR4IU v/XpiQLGxCwkr4L8AA0B+ob0CpsK0AAAAASUVORK5CYII= (https://portfolio.wsj.com/portfolio?mod=WSJ_port_quotechicklet)Your ValueYour Change Short position like mad. Thirty minutes of informed search revealed that in order to bill for a trauma activation, the Medicare Claims Processing Manual, or MCPM, requires that the trauma team be activated either by EMS—an ambulance—or by an another hospital transferring the patient. This makes sense. If you want to bill $10,000 for a trauma team, you can't unilaterally decide that the patient required a trauma team. That would be like a supermarket being able to require you to buy $10,000 worth of chicken because they decide that's what you're hungry for.

7. Have the combined medical and legal knowledge to understand the implications of the coders' rules. Since we drove my son to the ER, the trauma-activation requirement was not met. This was a huge failing by my insurance company when it initially allowed the charge. Their adjusters should know that a payer shouldn't pay for a trauma activation unless there is documented evidence of an EMS or outside hospital activation.
I called the billing supervisor at the hospital. He was very friendly and professional and told me why the bill was valid.

8. Unleash the hounds. I let the billing supervisor speak for a moment, and then cut him off using the ammo I had acquired from billing-coders' blogs. "You billed a G0390 for trauma-team activation. But chapters 4 and 25 of the MCPM require there be EMS or outside hospital activation if you are billing a G0390. There was no such activation here. So here is what I need you to do: Remove that $10,000 charge and reissue the bill."
He was silent for a moment. And then he said, " Let me talk to my supervisor."

9. Be graceful in victory and realize you got lucky. To the hospital's immense credit, they sent a refund to our insurance company and reissued the bill without the $10,000 trauma activation. They could have refused. What would my recourse have been? To hire a lawyer? Try to interest my insurer in fighting over a measly $10,000 charge? That is a tiny line item in their book of business.
I believe in free-market solutions almost as strongly as I believe in abiding scientific principles such as relativity. I think the quality of care in the U.S., if you have the right insurance, is the finest in the world. As a biotech executive, I think the U.S. is responsible for driving more global medical innovation than any other nation.
But our actual delivery system is just a mess. The new Affordable Care Act is just "a complex and somewhat ugly patch on a complex and somewhat ugly system," as Princeton economist Uwe Reinhardt put it. Nothing will change until we shift incentives away from overuse and upcoding, but both Democrats and Republicans have spent more of their time attempting to scare their constituencies than they have deeply examining incentives and proposing any solutions—free market or otherwise. Which leads me to:

Step 10. Skip medical school and law school and get your child a helmet.
Dr. David is co-founder and chief strategy officer of Organovo Inc., a biotech company in California.
</article>

Baba Booey

09-03-2014, 12:34 PM

This person is full of shit.

I'm a healthcare administrator, CEO/CFO stuff (I'm both actually where I'm at now).

Please allow me to debunk this fraud, see my responses in RED

(Oh, and btw - it's probably a copyright infringement to reproduce an article that needed a subscription to view, so be careful).

1. Get yourself a job as a doctor or nurse. I've served on trauma teams in two of the busiest hospitals in New York City, and I know what a trauma-team activation looks like: doctors, nurses and residents running and yelling, IV lines, monitors. You know one when you see one. Nothing like that happened around my son. So I picked up the phone and told the hospital that the trauma charge was a mistake. The billing agent explained that it was hospital protocol to call a trauma team when there is internal bleeding in a head injury. I argued, correctly, that it wasn't clinically indicated. THIS HOSPITAL PROTOCOL IS PROBABLY REQUIRED BY CMS (MEDICARE) OR THE DHHS (STATE MEDICAID AGENCY) AND NOT FOLLOWING SUCH PROTOCOL MAY PUT THE HOSPITALS LICENSE IN JEOPARDY.

2. Have or gather the legal knowledge to know when you are being lied to. The hospital billing agent wasn't a physician and couldn't refute my clinical judgment, so she told me it was "county protocol" to call a trauma in such cases. This was a bluff, meant to get me off the phone by hiding behind regulations, a very effective tactic used by hospital administrators. I called her bluff and said if she could show me the county regulation requiring a trauma team for an 11-day-old head injury, I'd happily pay my bill. She said she'd have the head of emergency services call me. THIS IS CLASSIC PASSIVE AGGRESSION, BILLING CLERKS DON'T KNOW THIS SHIT - THE TRAUMA COORDINATOR DOES. ASKING A BILLING CLERK FOR THIS INFORMATION IS LIKE ASKING THE FUCKING JANITOR TO DIAGNOSE YOUR CAT SCAN. AND, BILLING CLERKS ARE PAID LIKE TEN BUCKS AN HOUR, THAT'S NOT ENOUGH MONEY TO PAY SOMEONE TO LIE/COVER UP THIS (PAUSE FOR DRAMA) MASSIVE BILLING FRAUD. HER DESCRIPTION OF THIS ACTUALLY MADE ME LAUGH OUT LOUD.

3. Have the resources to pay huge bills up front while you wait the months it takes to correct billing errors. Two weeks later, the physician head of emergency services called. He was professional, knowledgeable and in agreement that I should not have been billed for the trauma activation. He'd call the billing team to tell them so. A week later, the hospital wrote to say that they were delighted I'd had the chance to speak with the head of emergency services, but the billing department had determined that the $10,000 charge was accurate. PHYSICIANS DON'T KNOW THIS SHIT - UNLESS THAT PHYSICIAN IS ALSO THE TRAUMA COORDINATOR WHICH IS RARE BUT HAPPENS SOMETIMES. STANDARD ER DOCS DON'T KNOW THIS SHIT NOR DO THEY CARE, THEY'RE JUST FOCUSED ON STOPPING THE BLEEDING AND PUTTING YOUR BRAINS BACK INTO YOUR SKULL.

4. Understand that only the billing department, not the physicians, decides what is billed. The hospital we visited is a level-one trauma center, so it will bill for a trauma activation at every possible opportunity. It's how any sane person would run such a cost-intensive business. Hospitals will always "upcode"—bill for as intensive a level of care as they can legally get away with. 100% TOTAL CROCK OF SHIT, THIS PERSON COULDN'T BE MORE WRONG. NOBODY "DECIDES" WHAT'S BILLED. PROVIDERS & NURSES DOCUMENT THE PATIENT CHART, THE CHART IS REVIEWED BY CODERS AND SYMPTOMS, DIAGNOSIS, ETC. ARE CODED BASED ON A STANDARDIZED CODING SYSTEM, BILLERS MECHANICALLY TAKE THOSE CODES AND CREATE BILLS.

5. Know where the hospital billing managers go to decide what kind of upcoding they can get away with. Most hospital billing guidelines, whether for Medicare or private insurers, are derived from a several-thousand-page manual published by the Centers for Medicare Services called the Medicare Claims Processing Manual. You can access it online at CMS.gov (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html), although it is impenetrable. But here's a secret: There are lots of blogs out there written by the hospital coders that do the billing, and they blog about how to ensure a hospital can make their bill stand up to the payers—i.e., insurers—whose job is to negotiate the bill down. NO HOSPITAL UPCODES ON PURPOSE, 99% OF THE TIME IT'S BASIC ERRORS - YES, PEOPLE MAKE ERRORS. UPCODING IS MEDICARE FRAUD AND CEO/CFO'S LIKE ME GO TO JAIL FOR THIS SHIT. AGAIN, JUST MORE DRAMA BUT IT PROBABLY SOUNDS REALLY COOL TO THE AVERAGE CONSUMER.

6. Google (http://quotes.wsj.com/GOOGL) GOOGL +0.34% (http://quotes.wsj.com/GOOGL)Google Inc. Cl A (http://quotes.wsj.com/GOOGL)U.S.: Nasdaq$590.66+2.03+0.34%Sep 3, 2014 12:51 pm Volume (Delayed 15m) : 959,782 P/E Ratio 29.96Market Cap $394.32 Billion Dividend Yield N/ARev. per Employee $1,321,030595.00592.50590.00587.5010a11a12p1p2p3p0 9/03/14 Sony's Smartphone Offering: Lo... (http://blogs.wsj.com/digits/2014/09/03/sonys-smartphone-offering-longer-battery-life-playstation-streaming/)09/03/14 Is Your Food Safe? Baidu's New... (http://blogs.wsj.com/chinarealtime/2014/09/03/is-your-food-safe-baidus-new-smart-chopsticks-can-tell/)09/03/14 Nokia Plans to Unfurl New Mobi... (http://online.wsj.com/articles/nokia-plans-to-unfurl-new-mobile-map-app-1409741865)More quote details and news » (http://quotes.wsj.com/GOOGL?mod=articleInlineTicker)GOOGL (http://quotes.wsj.com/GOOGL) inhttp://www.debatepolicy.com/image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAKwAAAAgCAYAAAC PQ5N7AAAAGXRFWHRTb2Z0d2FyZQBBZG9iZSBJbWFnZVJlYWR5c cllPAAAA2hpVFh0WE1MOmNvbS5hZG9iZS54bXAAAAAAADw/eHBhY2tldCBiZWdpbj0i77u/IiBpZD0iVzVNME1wQ2VoaUh6cmVTek5UY3prYzlkIj8+IDx4On htcG1ldGEgeG1sbnM6eD0iYWRvYmU6bnM6bWV0YS8iIHg6eG1w dGs9IkFkb2JlIFhNUCBDb3JlIDUuMy1jMDExIDY2LjE0NTY2MS wgMjAxMi8wMi8wNi0xNDo1NjoyNyAgICAgICAgIj4gPHJkZjpS REYgeG1sbnM6cmRmPSJodHRwOi8vd3d3LnczLm9yZy8xOTk5Lz AyLzIyLXJkZi1zeW50YXgtbnMjIj4gPHJkZjpEZXNjcmlwdGlv biByZGY6YWJvdXQ9IiIgeG1sbnM6eG1wTU09Imh0dHA6Ly9ucy 5hZG9iZS5jb20veGFwLzEuMC9tbS8iIHhtbG5zOnN0UmVmPSJo dHRwOi8vbnMuYWRvYmUuY29tL3hhcC8xLjAvc1R5cGUvUmVzb3 VyY2VSZWYjIiB4bWxuczp4bXA9Imh0dHA6Ly9ucy5hZG9iZS5j b20veGFwLzEuMC8iIHhtcE1NOk9yaWdpbmFsRG9jdW1lbnRJRD 0ieG1wLmRpZDowMDgwMTE3NDA3MjA2ODExODIyQTg2NzE2NDA3 MDUyRCIgeG1wTU06RG9jdW1lbnRJRD0ieG1wLmRpZDo5RkRFNU I4NDE0QjYxMUUzOTMzQ0M4QjgyNEMyMjcwNSIgeG1wTU06SW5z dGFuY2VJRD0ieG1wLmlpZDo5RkRFNUI4MzE0QjYxMUUzOTMzQ0 M4QjgyNEMyMjcwNSIgeG1wOkNyZWF0b3JUb29sPSJBZG9iZSBQ aG90b3Nob3AgQ1M2IChNYWNpbnRvc2gpIj4gPHhtcE1NOkRlcm l2ZWRGcm9tIHN0UmVmOmluc3RhbmNlSUQ9InhtcC5paWQ6MDE4 MDExNzQwNzIwNjgxMTgyMkFCRDlGMTk2MEE1QzIiIHN0UmVmOm RvY3VtZW50SUQ9InhtcC5kaWQ6MDA4MDExNzQwNzIwNjgxMTgy MkE4NjcxNjQwNzA1MkQiLz4gPC9yZGY6RGVzY3JpcHRpb24+ID wvcmRmOlJERj4gPC94OnhtcG1ldGE+IDw/eHBhY2tldCBlbmQ9InIiPz7PuBBXAAAEoElEQVR42uxci3GjMB AVnmuAFkgJXAchJXAl4BLsEqwSohJMCSEdnEs4WqAEn8hImc16 JQQSRk70ZjQeM1jsSk/7E3J2vV5ZQsKj4JdvB8/Pz2kU40IpW4WuCdkGj/5y4vrFo89PvL+/35ewCVHhjSCrJle3sM+Toc8XS58H9Tum7nkJamGllTTFBU9yBf SOfb3K1hDXj7LxO04aHCwXjJPZq4EVEZGvUq0e58FR7+qnhwTj IOwd+ikMZH0UF1oqYjRK30sEZH1bsFA1erX4LuD7UlyQXFETtp HWlztY2cM3iv9GT/H7weQuUJy59wgBKA+p4ZqhD+D5QRf/TgW+2diQcNDVT1kDyrpmqvE7Tx4Hz8YDnxHtDxrU8gG9RYG+dx vLI1Tc+mLglB9hpwgprWz1ja1rqwZ2iMn1JfhVCQ7UqlVEdpnc SlkuG2l02NEYyijQgobGoGRoJgir9aiIpE046Kyz9Vw9qwLXj2 DxFxNGoVWf9Yz7+4V6zLHytWFsjX0qDpGySK8vlhJ2tLK17KAl Sh6useHJIVPXk1DdmbA4McELZvx+NshVAZLA8ILSWZP11bAoTW N0MiRCc+7vF+oxh7CUPKbqy6QsknMfskjeXVxDgs40CLKzBlmQ reOmtZAzc30TT9jbhCepLGR9JD3uKovkWulqYTnotBhJCsz0AZ G1swigXR4ufwm18nvkvjplaUvw+3blCa0NpRy8MFtkMaAlzZGF OhKLPSfKTjgjx+N0NHiDOfcv1WOOhzqChWkj42JZrISV5OwkST vkLoSyrgUidjlhqbU7rIGF6QkXTy0IwdYt6uMBNNUeW2ISO0TK GumMCWvb+eGGygsPcP9SPeYQljsmrl9kkTy7kUVt+d/I4lIlgBsHo5U9oQkQM8KBAVnKxmLtcpegfQYqtQhwOxOlO2EYX OEYV1cTJZ8tEFqPVWWRJOZEcjaddI2bBvJmAch18EyCYF86s2w t7lkEHCSXCeBs3Z2ugSUsxs7xPm4h39xtvwuzb/cVKxHWNQY7JlrEC6eyFmFlfUtMArjhRpFkIKxrx/z2wak42rSIukSHb0JYkHnC2PKoiLzkua2Kg3NAWk7EtSErAx27/zZxwkYhwWhlBzDhvokQTr5qEB4UgZOthJ9IWODKP4irCOwDXHc rN4pdXWJbGF9TKCy/CYH8m+jhLIv03KQsswgLrGwIMuHk68BuNxViAN7tKwkyndHA9g GfyViYt8e20MNJFriTpch6I4t+xTUbDyFaThwwEK9yYhW4vGhs O3HQMPr1RZ9jFa4nDjLH/igdO+QdckLfKTmmdPzLbjczBvCMC5ve3oRjv1SPqWdoPVy4oI/VzJZF82/rM12tgbAtiwfjQO6RnJUlzAmV2HFkZUrPEGErPbxlgcZytzEZq MQqxmRLMPuhu15NwD7wYt4Hdstb6OEliyTrF1ky3/8lCHTMG7pPzuIv3lcGV70WCpCchHzevfWg8iIYXn7KYkrqYyHs PzAhTysG+wmRYe7/EuwikLkGZO0SWRNiJOwYAlxVOyMXdWXzjzgnJMImJCTCJiR4IU v/XpiQLGxCwkr4L8AA0B+ob0CpsK0AAAAASUVORK5CYII= (https://portfolio.wsj.com/portfolio?mod=WSJ_port_quotechicklet)Your ValueYour Change Short position like mad. Thirty minutes of informed search revealed that in order to bill for a trauma activation, the Medicare Claims Processing Manual, or MCPM, requires that the trauma team be activated either by EMS—an ambulance—or by an another hospital transferring the patient. This makes sense. If you want to bill $10,000 for a trauma team, you can't unilaterally decide that the patient required a trauma team. That would be like a supermarket being able to require you to buy $10,000 worth of chicken because they decide that's what you're hungry for. I DISMISSED THIS STATEMENT AS RANDOM BABBLING DUMBFUCKERY.

7. Have the combined medical and legal knowledge to understand the implications of the coders' rules. Since we drove my son to the ER, the trauma-activation requirement was not met. This was a huge failing by my insurance company when it initially allowed the charge. Their adjusters should know that a payer shouldn't pay for a trauma activation unless there is documented evidence of an EMS or outside hospital activation. I called the billing supervisor at the hospital. He was very friendly and professional and told me why the bill was valid. SAME AS #6, THE PATIENT CHART REALLY NEEDS TO BE REVIEWED TO FIND OUT WHAT HAPPENED. AT THIS POINT AFTER READING ALL OF THIS FUCKING BULLSHIT THIS PERSON HAS ZERO CREDIBILITY WITH ME AND I HAVE LITTLE DOUBT THAT SHE'S FUCKING THIS PART UP ALSO.

8. Unleash the hounds. I let the billing supervisor speak for a moment, and then cut him off using the ammo I had acquired from billing-coders' blogs. "You billed a G0390 for trauma-team activation. But chapters 4 and 25 of the MCPM require there be EMS or outside hospital activation if you are billing a G0390. There was no such activation here. So here is what I need you to do: Remove that $10,000 charge and reissue the bill." He was silent for a moment. And then he said, " Let me talk to my supervisor." ACTUALLY, THE BILLER OR THE DEPARTMENT MANAGER NEEDS TO HAVE A PROVIDER OR A CODING SUPERVISOR REVIEW THE CHART TO MAKE SURE THE CODING WAS DONE ACCURATELY. AGAIN, THE CODING IS BASED ON CHART DOCUMENTATION AND IF THE CHART IS DOCUMENTED THAT TRAUMA SERVICES WERE PROVIDED THEN THE BILLING IS APPROPRIATE. OR THE CHART IS WRONG AND IT COULD BE DEEMED FRAUD BY MEDICARE. THE POINT BEING - CODERS, BILLERS DO NOT DETERMINE THIS, PROVIDERS DO VIA CHART DOCUMENTATION.

9. Be graceful in victory and realize you got lucky. To the hospital's immense credit, they sent a refund to our insurance company and reissued the bill without the $10,000 trauma activation. They could have refused. What would my recourse have been? To hire a lawyer? Try to interest my insurer in fighting over a measly $10,000 charge? That is a tiny line item in their book of business. I believe in free-market solutions almost as strongly as I believe in abiding scientific principles such as relativity. I think the quality of care in the U.S., if you have the right insurance, is the finest in the world. As a biotech executive, I think the U.S. is responsible for driving more global medical innovation than any other nation.
But our actual delivery system is just a mess. The new Affordable Care Act is just "a complex and somewhat ugly patch on a complex and somewhat ugly system," as Princeton economist Uwe Reinhardt put it. Nothing will change until we shift incentives away from overuse and upcoding, but both Democrats and Republicans have spent more of their time attempting to scare their constituencies than they have deeply examining incentives and proposing any solutions—free market or otherwise. Which leads me to:

Step 10. Skip medical school and law school and get your child a helmet.
Dr. David is co-founder and chief strategy officer of Organovo Inc., a biotech company in California.

TRUE, MISTAKES HAPPEN BUT THE BEST WAY TO HANDLE THIS IS BY TALKING TO THE CFO OR THE COO DIRECTLY. HEALTHCARE BILLING IS PROBABLY THE MOST COMPLEX BILLING CYCLE INDUSTRY OUT THERE AND THERE ARE A LOT OF LAYERS OF FLUFF IN THE PROCESS. IT'S EASY TO GET BURIED IN ALL THIS FLUFF. THIS PERSON DID THE RIGHT THING BY BEING TENACIOUS AND ASKING EVERYONE QUESTIONS BUT (I'M CALLING HIM A HER BUT REALIZE NOW SHE'S A HE) HIS SUMMARY IS VIRTUALLY COMPLETELY WRONG AND TO PUBLISH IT AS ACCURATE IS GROSSLY IRRESPONSIBLE.

/rant

NightTrain

09-03-2014, 01:17 PM

Baba Booey

09-03-2014, 01:52 PM

I don't know much about it, I have awesome health insurance through IBEW.

My youngest son was born a month premature, I was absolutely stunned by the charges we racked up in the week we spent in the NICU. It was several hundred thousand by the time we got out of there and everything was tallied up... and that was back in 2003. Not that anyone would decline anything in a situation like that, right? When you see your newborn son struggling to breathe, there isn't anything you won't do to help him.

My little brother spent 3 weeks in the ICU here in Wasilla, and other 3 weeks at Providence ICU in Anchorage within the last year. Total bill for those two was right under 2 million, and he had no insurance so that'll be picked up by Taxpayers, I'm guessing.

Primi's and bad babies are huge, huge cost cases often and a lot of it is malpractice (ie: tort reform) driven to be honest.

But a bad baby can be a lifetime of huge annual health costs, this is the reason a lot of hospitals closed their birthing units and nurseries.

tailfins

09-03-2014, 02:23 PM

NightTrain

09-03-2014, 02:52 PM

Was any attempt made to garnish your wages or attach your assets?

Nope. All my kids have double coverage from me and the ex-wife so I just let the insurance companies squabble between themselves over the bills. My insurance was threatening to sue the other one here a while back over some money, but they worked it out before it went to court.

Whenever they try to get me in the middle of a dispute, I refer them to the other company. I'm not the insurance professional and just tell them straight up I know nothing about the subject and bow out. My yearly deductible is almost always paid in the first couple of months and I really don't care which one of them gets shafted by the other!

I have a very dim view of any insurance company to begin with, stemming from years of being screwed over by most of them back when I was a young man getting in accidents. If they can screw a kid over legally, I learned they'll do it in a New York Minute - right or wrong.

Baba Booey

09-03-2014, 05:33 PM

I don't know much about it, I have awesome health insurance through IBEW.

My youngest son was born a month premature, I was absolutely stunned by the charges we racked up in the week we spent in the NICU. It was several hundred thousand by the time we got out of there and everything was tallied up... and that was back in 2003. Not that anyone would decline anything in a situation like that, right? When you see your newborn son struggling to breathe, there isn't anything you won't do to help him.

My little brother spent 3 weeks in the ICU here in Wasilla, and other 3 weeks at Providence ICU in Anchorage within the last year. Total bill for those two was right under 2 million, and he had no insurance so that'll be picked up by Taxpayers, I'm guessing.

Taxpayers won't pick that up, btw. Assuming these institutions are NFP's they'll eat the loss and try to make it up by collecting more from other services. Bad debt.

If they're FP's, bad debt and directly to shareholder distributions.

Most places go through minimal collection efforts. Wage garnishments and judgments are kind of rare, in the NFP world it's frowned upon a bit.

A FP would repossess your toaster if they could.