… my rule of thumb is that anything advertised on TV to Medicare beneficiaries is very likely a fraud (e.g., Medicare Advantage, the Scooter Store, anything endorsed by Wilford Brimley, and now these urine catheters.)
Free link
intercst
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“I rob banks because that’s where the money is.” - Wille Sutton.
Of course during my career, Medicare/Medicaid NEVER increased my reimbursement. And seemed to randomly denied payment for services rendered which then cause my billing agent to refile. Often resulting in getting paid but about 1 year late.
I may have commented on the billing issue I had with my GP when I first went on Medicare. Turned out to be a coding mistake by the Doc’s billing person. He first used the code for a routine checkup, when I was actually having my “welcome to Medicare” visit. I pointed out the error. He then billed as “first routine checkup”, which was also wrong and bounced by Medicare. I finally had to print out an explanation of the three codes and when to use them, and give it to the clerk at the office.
They never did get the billing for the aortic aneurysm screening right. Everything I see from Medicare says a once in a lifetime screening is free. They billed something wrong, and Medicare applied part of the charge to my annual deductible, so the office billed me for the rest. I kept barking about it, showing the office what coding to use. The office eventually rebilled it to Medicare, but Medicare denied the rebill. Medicare says I can’t contest a billing until I receive the printed form with the codes for why they denied the claim, but I never received the printed form. So, I ended up being out a couple hundred beans.
Steve
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I’m going round and round with some blood tests. Medicare denies payment because it’s not medically necessary, doctor’s staff resubmits some new coding to lab, lab requests from Medicare, Medicare denies, and we start all over.
It almost seems there’s someone at Medicare that doesn’t want to provide payments for service.
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My aortic aneurysm screening cost $95. Medicare approved it, but said I owed a $19 copay. I filed an appeal with a link to the preventative screening guidelines saying its supposed to be without cost sharing. I’ll let you know what they say. I’m assuming the doctor’s office put the wrong diagnostic code on the order that went to the radiology center.
intercst
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I find that hard to believe. Over the past 30 years, the Medicare budget increased by 500%, during a period where the CPI increased by slightly over 100%.
You probably need to hire a more proficient billing consultant. You’re leaving a lot of money on the table.
intercst
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That sounds really cheap. I received two bills: one from Beaumont Hospital for the procedure, and another one from some guy for interpreting the results.
The charge for the interpretation was $80, which, after Medicare adjustment and payment, left $7.06 for me.
The actual procedure was $1589.00. Of that, Medicare covered everything except $224.33, which they said I owed after the deductible.
I have conventional Medicare.
Steve
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We discussed this a while back. The aortic aneurysm screening is supposed to cost about $100 – $1,500 is more than Medicare pays for a colonoscopy. The Beaumont hospital must be doing something to pad the bill.
I drove past the hospital to one of those storefront medical imaging places that do x-rays, MRIs and ultrasounds. They have a radiologist in the building and give you an all-in price for the procedure and the doctor’s reading of the scan. I got an email with the results about an hour after I drove home.
intercst
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Don’t confuse overall department spending on an ever increasing population with reimbursement rates to an individual physician. More and more boomers having more procedures and visits while my “time unit” rate stayed the same. Really no arguing/negotiating with the government, it is a take it our leave it proposition. Plus, my billing agent used to play for the other side so knew how they operated.
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Well, Medicare paid some $1300 of Beaumont’s charge, applying the other couple hundred to my deductible for the year.
Have you logged in on Medicare’s page to look at the billing they have in process?
Steve
Yes. And my Medigap insurer has already processed the charge and sent me the statement with the amount left on my deductible.
Didn’t you tell me that your doctor said “They charged $1,500 for that !?”
At the Veterans Administration they reported that they spent an average of $143 per screening.
https://www.jvascsurg.org/article/S0741-5214(21)02214-X/fulltext
Maybe you should report it as Medicare fraud and try to get back the $230 deductible they skinned you for? The only thing I can imagine is that there is some kind of crazy high facility fee that the Beaumont hospital is charging you, but there is no way that a “facility fee” would be 10 times the cost of the procedure.
That’s the reason I get my blood tests, x-rays, etc. done at a storefront shop where I won’t get dinged for the hospital ‘facility fee’ whenever possible.
intercst
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Sure, but if you’re covering the OR and supervising a half dozen patients under sedation or anesthesia, you’re applying your “time unit” simultaneously. In any other profession, that would be called “double billing”.
My favorite is ophthalmology. If I get a thorough eye exam done at Walmart, a credentialed Doctor of Optometry performs all the tests and it costs about $120.
At the ophthalmologist’s office, a high school intern does all the testing. Then the ophthalmologist looks at me for about 5 minutes at the end of the 45 minutes of testing and tells me I’m fine. Cost is $850, and the doctor’s notes includes the phrase “all tests were performed by a medical assistant trained by me.” What it doesn’t say is that the medical assistant’s time is being marked up by about a factor of 20. That’s what makes Ophthalmology such a lucrative specialty – the opportunity to price gouge on your medical assistant’s time.
Doctor Glaucomfleken explains:
Minimizing the “skim” – the key to retiring early.
intercst
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intercst
Extremely telling and interesting post hitting hard on the deepest levels of septic garbage under our ever more insane health system.
In Europe there is no pretense that Adam Smith style competitive markets can be somehow be coereced to emerge out of significant % for the provision of national healthcare.
d fb
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@intercst Instead doctors broke up the number of procedures it takes to get the job done into a lot of things that could be billed. There are often more codes now per needed medical diagnostic and course of treatment.
Pay went horizontal to improve. It does not often to vertical.
Yep. The big multi-specialty clinic in town brought in a healthcare MBA as CEO. Next thing you know, they bought a strip shopping center and filled it with medical coders to strip mine the charts for billing opportunities. No doubt it’s the most profitable part of the operation.
That’s the reason you have to be very careful how you answer questions during an office visit with a doctor. Say the wrong thing, and it might trigger a $400 bill once the coders get a hold of the chart long after you left the office.
intercst
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Wow. Upon consideration not surprising but thoroughly nauseating.
d fb
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What he said was a bit more colorful, along the lines of “they charge $1500 for that? That’s bull s4!t”.
But, somehow, it was within Medicare’s guidelines.
They would have charged me for the deductible, regardless what the top line was.
Steve
The $1,500 scan you got billed for is not the “preventative screening scan”. It may be a legitimate charge for whatever procedure and diagnostic codes that were on the doctor’s order, but those codes didn’t describe a “preventative screening scan” which should be done without cost sharing. A preventative screening exam isn’t charged against your deductible, it’s cost free to you.
intercst
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And the “time unit” takes into account if I’m doing the case myself or supervising. Either way, Uncle Sam never gave me a raise.
I’m not sure of your reasoning here. Are you saying that you’ve actually visited both an optometrist and ophthalmologist to get a prescription for a new pair of eyeglasses and compared identical experiences?