Medical Coding, Billing and Claims Handling

Collarspace Discussion Forums

Home Login Search

Medical Coding, Billing and Claims Handling

View related threads: (in this forum | in all forums)

Logged in as: Guest

All Forums >> [Casual Banter] >> Off the Grid >> Medical Coding, Billing and Claims Handling

Page: [1]

Message

<< Older Topic Newer Topic >>

Medical Coding, Billing and Claims Handling - 11/13/2008 10:05:37 AM

candystripper

Posts: 3486
Joined: 11/1/2005
Status: offline

If you have 'great' coverage you may nonetheles still find yourself facing significant losses under your health insurace.

Medical coding refers to the 'back office' practices of your insurance company. To be eligible for payment, a claim must be coded properly. That is, the hospital, MD or whatnot must input the correct data for that claim. if your MD, e.g., pays bottom dollar for medical coding and billing services, he likely will be paid less than the full amount. Many MDs will then turn around and bill you for the 'balance'

Hospitals 'price' goods and services using a Charge Master. This is a fancy computer program that shifts costs away from the uninsured and underinsured onto the well-insured. Prices can fluctuate through a single day, depending on the mix in the hospital's patient load. That's why hospital bills sometimes are baffling. That 'infestious disease control device' may have been a 2 cent bandade.

Medical Billing is nothing more than collections work. Once again, if your MD has bought poorly skilled Medical Billing and Coding services, you may be asked to pay for a claim which, if properly submitted, would be paid by the insurance company. Of course, it is also true that your insurance company may misbehave and refuse to honor a legitimate request for payment.

If you find yourself financially distressed due to medical bills or inability to access care, spend some time trying to solve the problem, or hire a qualified lawyer to do so for you.

Peace out.

candystripper

P.S. This information is only true as to folks in the U.S.

Profile

Post #: 1

RE: Medical Coding, Billing and Claims Handling - 11/13/2008 10:54:22 AM

CalifChick

Posts: 10717
Joined: 10/28/2007
From: California
Status: offline

It is these sorts of gross generalizations that make my work more difficult. Please stop spreading misinformation. Since you obviously don't work in the field of the business of medicine, perhaps you should stick to giving advice on tax law... wasn't that your chosen field?

Cali

_____________________________

AKA "The Undisputed Goddess of Sarcasm", "Big Bad Cali" and "Yum Bum". Advisor to the Subbie Mafia, founding member of the W.A.C. and the Judgmental Bitches Brigade, member of the Clan of the Scarlet O'Hair-a's and Team Troll

(in reply to candystripper)

Profile

Post #: 2

RE: Medical Coding, Billing and Claims Handling - 11/13/2008 11:01:14 AM

sirsholly

Posts: 42360
Joined: 9/7/2007
From: Quietville
Status: offline

quote:

ORIGIONAL:candystripper

Hospitals 'price' goods and services using a Charge Master. This is a fancy computer program that shifts costs away from the uninsured and underinsured onto the well-insured. Prices can fluctuate through a single day, depending on the mix in the hospital's patient load. That's why hospital bills sometimes are baffling. That 'infestious disease control device' may have been a 2 cent bandade.

As someone who has spent my entire adult working in the medical field...i will tell you this is complete bullshit.

_____________________________

PICKED UPON
TECHNO-DOLT
MEMBER OF THE SUBBIE MAFIA
GRACEFULLY CHALLENGED :::::splat:::::
BOOT WHORE
VAA/S FAN

GIVES GOOD HEART (Lushy)

CREATOR OF MAYHEM (practice)

(in reply to candystripper)

Profile

Post #: 3

RE: Medical Coding, Billing and Claims Handling - 11/13/2008 11:30:06 AM

sirsholly

Posts: 42360
Joined: 9/7/2007
From: Quietville
Status: offline

quote:

ORIGINAL: CalifChick

It is these sorts of gross generalizations that make my work more difficult. Please stop spreading misinformation. Since you obviously don't work in the field of the business of medicine, perhaps you should stick to giving advice on tax law... wasn't that your chosen field?

Cali

agree...

_____________________________

PICKED UPON
TECHNO-DOLT
MEMBER OF THE SUBBIE MAFIA
GRACEFULLY CHALLENGED :::::splat:::::
BOOT WHORE
VAA/S FAN

GIVES GOOD HEART (Lushy)

CREATOR OF MAYHEM (practice)

(in reply to CalifChick)

Profile

Post #: 4

RE: Medical Coding, Billing and Claims Handling - 11/13/2008 1:49:11 PM

soul2share

Posts: 7084
Joined: 12/18/2007
From: somewhere out there.....
Status: offline

quote:

ORIGINAL: candystripper
That infectous disease control device' may have been a 2 cent band-aid.

Typo fixed.....free of charge......

I'd be interested in seeing your sources on the "facts" you list....especially since judging from the comments of others that this isn't your chosen career field. You seem to be slightly obsessed with various forms of the topic today......

(It's like a train wreck...God help me, I can't stop looking at her posts!)

_____________________________

I have to stop saying "How stupid can you be?"...people are starting to take it as a challenge!

*Not a fuck was given.*

(in reply to candystripper)

Profile

Post #: 5

RE: Medical Coding, Billing and Claims Handling - 11/13/2008 2:52:52 PM

LaTigresse

Posts: 26123
Joined: 1/15/2006
Status: offline

Sure there are mistakes in medical billing. Read the damned statements and question them.

I once had a $2,900.00 claim denied by my insurance company because the person entering it at the hospital made an error in how they coded an ER visit. I had to make some phone calls, get it fixed and resubmitted. The insurance company paid. Problem solved.

Sure it sucked, but yanno, I am human and I make mistakes. Silly of me to assume the person working in the hospital's billing department would be anything other than human too.

_____________________________

My twisted, self deprecating, sense of humour, finds alot to laugh about, in your lack of one!

Just because you are well educated, articulate, and can use big, fancy words, properly........does not mean you are right!

(in reply to KatyLied)

Profile

Post #: 6

RE: Medical Coding, Billing and Claims Handling - 11/13/2008 3:02:27 PM

candystripper

Posts: 3486
Joined: 11/1/2005
Status: offline

Lemme give you an example, LaTigress. I sued a vertically integrated insurance company/hospital/MDs group. The client had undergone a hysterctomy and had been sent a bill for $5,000 to pay out of pocket.

What did the vile evil predatory company actually charge -- internally -- for the costs of the surgery? $500. Once I proved that to the Judge, it was all over but the crying.

Insurance is poorly-understood by folks who have not penetrated the fog...which is why I wrote the Op.

candystripper

(in reply to LaTigresse)

Profile

Post #: 7

RE: Medical Coding, Billing and Claims Handling - 11/13/2008 3:16:54 PM

susie

Posts: 1699
Joined: 11/21/2004
Status: offline

quote:

ORIGINAL: candystripper

Hospitals 'price' goods and services using a Charge Master. This is a fancy computer program that shifts costs away from the uninsured and underinsured onto the well-insured. Prices can fluctuate through a single day, depending on the mix in the hospital's patient load. That's why hospital bills sometimes are baffling. That 'infestious disease control device' may have been a 2 cent bandade.

I may not be in the US but I spent 10 years working for a large American hospital company in their hospitals outside of the US. Yes they certainly have a Charge Master which is set normally once a year. Never in all my time working in the field were costs set differently for insured and uninsured and the notion is ridiculous. I can assure you that there is no way prices fluctuate daily. Finance teams do not have the resources or time to consider doing that.

(in reply to candystripper)

Profile

Post #: 8

RE: Medical Coding, Billing and Claims Handling - 11/13/2008 7:53:30 PM

OneMoreWaste

Posts: 910
Joined: 8/24/2008
Status: offline

quote:

ORIGINAL: LaTigresse
I once had a $2,900.00 claim denied by my insurance company because the person entering it at the hospital made an error in how they coded an ER visit. I had to make some phone calls, get it fixed and resubmitted. The insurance company paid. Problem solved.

Sure it sucked, but yanno, I am human and I make mistakes. Silly of me to assume the person working in the hospital's billing department would be anything other than human too.

I donno. I designed and run a billing system. Every week we process about 70,000 transactions, between one and two million dollars in sales, five thousand locations, over two thousand invoices. Again, that's per week, and during the Xmas season, the dollars and transactions triple. Currently it's pulling data in from three sources, but there have been times I've had to run it off of inputs from six different systems.

If I'm responsible for one mistake a month (and I've been doing this for eight years), it's a lot. Too much, in fact.

And so I expect my vendors to bill me correctly as well.

And for what it's worth, I can't make fucking heads or tails out of medical billing.

All I know is that somehow I end up paying a couple grand a year in medical insurance, and every time I go to the doctor I pay them too.

I'm just on the wrong side of the Lawyer & Lobbyist divide

_____________________________

-and the few still remember passion over rage-

(in reply to LaTigresse)

Profile

Post #: 9

RE: Medical Coding, Billing and Claims Handling - 11/14/2008 7:05:02 AM

LaTigresse

Posts: 26123
Joined: 1/15/2006
Status: offline

quote:

ORIGINAL: candystripper

Lemme give you an example, LaTigress. I sued a vertically integrated insurance company/hospital/MDs group. The client had undergone a hysterctomy and had been sent a bill for $5,000 to pay out of pocket.

What did the vile evil predatory company actually charge -- internally -- for the costs of the surgery? $500. Once I proved that to the Judge, it was all over but the crying.

Insurance is poorly-understood by folks who have not penetrated the fog...which is why I wrote the Op.

candystripper

Very few people even bother reading their policy, let alone question how they will be charged if a major medical event pops up. Insurance companies and medical providers know this and take advantage of it.

All of us need to be more responsible and proactive with our medical care. Take the time to actually READ our insurance policies instead of sticking them in a drawer unopened. Ask questions of our doctors instead of taking their word as law.

_____________________________

My twisted, self deprecating, sense of humour, finds alot to laugh about, in your lack of one!

Just because you are well educated, articulate, and can use big, fancy words, properly........does not mean you are right!

(in reply to candystripper)

Profile

Post #: 10

RE: Medical Coding, Billing and Claims Handling - 11/14/2008 6:24:04 PM

candystripper

Posts: 3486
Joined: 11/1/2005
Status: offline

quote:

Most people pay the Medicare Part B premium of $96.40* per month in 2008. This amount may change January 1, 2009. In some cases this amount may be higher if you didn’t choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you could have had Part B but did not sign up for it, except in special cases. You will have to pay this extra 10% as long as you have Medicare Part B.
Your Part B premium may be higher if your income is above a certain level.

http://www.medicare.gov/MedicareEligibility/home.asp?dest=NAV%7CHome%7CGeneralEnrollment&version=default&browser=IE%7C6%7CWinXP&language=English

quote:

I may not be in the US but I spent 10 years working for a large American hospital company in their hospitals outside of the US. Yes they certainly have a Charge Master which is set normally once a year. Never in all my time working in the field were costs set differently for insured and uninsured and the notion is ridiculous. I can assure you that there is no way prices fluctuate daily. Finance teams do not have the resources or time to consider doing that.

This is VERY complex stuff.

No one should read the Op and conclude 'O, that's what I ought to do'. Health insurance and access to care, as dicussed in the Op, is very U.S.-centric. I admit I know nothing about ChargeMasters in hospitals located in other parts of the world -- this thread isn't really pertinent to non-U.S. folks.

The bad news is, no matter how much they spend on their health insurance, U.S. folks may not be able to control their health care costs or get access to care -- a situtation which is considered the foremost reason people file for bankruptcy. It can also shorten a life or leave someone to suffer greatly.

You must use your own judgment when you read something on a Message Board, Blog, etc. If you find it doesn't fit with what you know, then perhaps it isn't worthwhile to parse through to see what else is said.

candystripper

(in reply to LaTigresse)

Profile

Post #: 11