Don’t bet on getting that aortic screening for free. My doc’s billing department, apparently, coded it wrong, so I got a bill for the Part B deductible. I barked at them. They rebilled it. Medicare rejected the rebill. So, I’m out $200+
Supposedly, I can contest the rejection of the rebill with Medicare, but I can’t contest it until I receive the printed “explanation of benefits”. They only send the benefits reports out once a quarter and, due to the timing, I should get the report with the coding explaining why they rejected it with the Q3 batch. I had the screening last March.
This is not the first time I have had a coding issue with the doc’s office. They billed my first check-up on Medicare wrong, twice. I had to do the legwork to show the doc’s billing person what the correct coding was for the “welcome to Medicare” visit. Medicare accepted the third billing, probably because they had totally rejected the first two, which had the wrong codes. For the screening, they had accepted it, and paid most of the $1500 charge.
That’s interesting. I figured the first screening was free, but if they found a problem that required continued surveillance, the subsequent screens would be subject to the 20% co-pay. You’re getting the subsequent screens for free, too?
It’s a better deal than I thought. Traditional Medicare is awesome. It’s takes a profoundly ignorant populace to imagine that for-profit healthcare is going to do anything for them.
The procedure code for a screening exam is 76706 (Ultrasound, abdominal aorta, real time with image documentation.) That’s for a simple ultrasound performed with a wand. The Medicare reimbursement is about $130 for 2023.
If they charged you $1,500, you must have gotten a more complicated 2D or 3D scan that normally isn’t used for screening.
That patients must research, teach other, and then theselves enforce correctness on supposed medical workers drowning in codes, being pushed/ordered by profit centers higher up to abuse said codes, and etc, is symptomatic of croxx purposes.
I will never forget my first experience being registered into the digitial system, interviewed, examined (including vitals, blood and urinalysis, x-rays, and given medications at a Spanish hospital when I became a resident there. At end of day, with everything done, I asked a supervisor lady where I should go to pay. She floored me by saying in Mallorcan inflected Spanish, smilingly, with gentle condescension: "This is a hospital What we do here is treat people as caringly, efficiently and effectively as we know how, so as to bring them to good health. Somewhere in Madrid there is an office where some accountant will review your residency and account for you, and then you will receive a billing from him. Here, we have no idea nor interest.
Blame democracy. We don’t have universal health care because Americans don’t really want it. The last time democrats made a modest effort in that direction with Obamacare they drowned in the red wave of the 2014 midterms.
The folks who would benefit the most from public health care, the lower paid working class who seem to make up the majority of voters in all those red counties and states simply don’t want it. Therefore we don’t have it.
The CPT code sets the price by determining what equipment is used, the ICD-10 code determines whether CMS approves the charge. I still find it strange that you were charged 10 times the Medicare reimbursement for CPT code 76706. Were there any other CPT codes involved with the billing? Or perhaps there was some kind of huge hospital “facility fee” added to the bill?
A guy from a cold, mountainous, state, ran for POTUS some years ago. He wondered aloud “why do people keep voting against their own best interests?” I would suspect we can thank what was described by a kid with spiky hair in a cartoon as “a weird, propaganda network” for brainwashing people.
I pulled the printed "Medicare Summary Notice’ that came in the mail.
Under “service provided and billing code”, it describes the procedure and shows a code of 93978-PO and it shows the “Medicare approved amount” of $1589.00. The footnotes are G, about the amount applied to my deductible, and H “the following policies L35755 A5591 were used when we made this decision”. During an on line discussion with someone at Medicare, she said they used a policy called “assumed billing” or some such thing. I would have to dig through the log of that conversation to find the exact term she used. At the time, what she was saying sounded like “we assume the care provided knows what he’s doing, so kick out the money to him, without inquiry, so he gets his money faster.”
I would not recognize the difference. If it gives a hint, the tech was sliding an oversized mouse-like thing over my abdomen.
When my doc looked at the bill, he said “they charge $1500 for that? That’s BS!” My doc does not have his own practice. He works in a clinic owned by one of the major hospital companies in metro Detroit.
Well, I wouldn’t take your doc’s opinion on the cost too seriously as I doubt he has much more of a clue about the overheads associated with “doing an ultrasound” than you or I. Or, come to that, the skillset required to obtain decent enough images to make the ultrasound worth doing (probably wouldn’t even know how to work the equipment) He’s likely receiving a pre negotiated salary…Joe Paycheck, no less…so isn’t likely to care that much in reality (even if his compensation package is based on his billing or collections, it’ll still be minus the responsibility of covering overheads…and that’s a real luxury) I doubt he’d put his money where his mouth is.
I know more than I care to about aortic aneurysms. Both those that are detected in time (my husband) and those that aren’t (my dad)…and those that’ve been inherited (my daughter)
I had a question about this a year ago or so. I used to think that ultrasounds were only used by ultrasound techs, whether for OB or just general scans. In that past, all ultrasounds that my wife (mostly pregnancy, once twins, so ultrasounds rather often) or I (kidney, other abdominal, and one more I’ll mention below) received were done by an ultrasound tech.
Last year, when my shoulder muscle detached from the bone, I required surgery to repair it. I had the surgery at a regular hospital, not the usual outpatient clinic, due to their determination of higher risk in my case. The orthopedic surgeon was there and his PA was there. Before the surgery, they prepped me with a nerve block, and the PA did that using an ultrasound to find the nerve he was injecting (in or near?). He used the ultrasound by himself and appeared to be proficient enough at it. That’s the first time I had a regular doc/PA do it instead of an ultrasound tech. After the nerve block took hold, and after I was rolled into the ER, they also used regular anesthesia during the surgery. Apparently the combo of nerve block and anesthesia has various advantages, one of which is less pain during the first 24-48 hours. It worked and I didn’t use any of the powerful pain pills they prescribed.