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One thing to be aware of in how all of this stuff works; oftentimes medical billing codes don't map 1:1 to exactly how things work in the hospital, so the medic

One thing to be aware of in how all of this stuff works; oftentimes medical billing codes don't map 1:1 to exactly how things work in the hospital, so the medical staff puts together a statement of everything they did, and then the billing staff (approximately) maps it to billing codes. This means that they'll overshoot on some codes to make up for other acts and overhead that doesn't have an exact billing code, and every medical provider has different places that they'll overestimate, and by different amounts. Additionally, as most people know, the billed amount is usually FAR in excess of what the insurance company actually pays. I'm not in the industry so I may be off base here, and someone who is can correct me, but I just finished Oreilly's excellent ("Hacking Healthcare") which is about how patient services and billing work.

danielweber 13y ago
http://www.thedailybeast.com/articles/2013/02/22/how-hospital-administrators-hide-the-umbrella.html http://www.thedailybeast.com/articles/2013/02/22/how-hospita... His expense report comes back from accounting with everything approved except the umbrella. He appends a note to the report explaining that the umbrella was destroyed in the line of duty and resubmits. Back comes the expense report, with a rather severe note from accounting to the effect that umbrellas are not on the list of allowable expenses. ...Our frustrated manager tears up the old report, then sits down and fills out a whole new form: $3.94 for lunch, $12.75 for laundry charges, and so forth. Which he sends to accounting with a note attached: SEE IF YOU CAN FIND THE UMBRELLA NOW!
matwood 13y ago
I had mallet finger once and they coded it as a broken bone with the associated costs. They wanted to charge me for a full broken bone and typical time spent with hundreds of dollars of costs when all the doc did was spend 5 minutes, give me a plastic splint and tell me to not bend the finger for 8 weeks. After many phone calls I finally got someone on the phone who realized how idiotic the code was and changed it to something more reasonable to the service rendered.

danielweber 13y ago

http://www.thedailybeast.com/articles/2013/02/22/how-hospital-administrators-hide-the-umbrella.html http://www.thedailybeast.com/articles/2013/02/22/how-hospita... His expense report comes back from accounting with everything approved except the umbrella. He appends a note to the report explaining that the umbrella was destroyed in the line of duty and resubmits. Back comes the expense report, with a rather severe note from accounting to the effect that umbrellas are not on the list of allowable expenses. ...Our frustrated manager tears up the old report, then sits down and fills out a whole new form: $3.94 for lunch, $12.75 for laundry charges, and so forth. Which he sends to accounting with a note attached: SEE IF YOU CAN FIND THE UMBRELLA NOW!

matwood 13y ago

I had mallet finger once and they coded it as a broken bone with the associated costs. They wanted to charge me for a full broken bone and typical time spent with hundreds of dollars of costs when all the doc did was spend 5 minutes, give me a plastic splint and tell me to not bend the finger for 8 weeks. After many phone calls I finally got someone on the phone who realized how idiotic the code was and changed it to something more reasonable to the service rendered.