How Would You Handle This Doctor-HSA Situation?

[somarco]

Lee, this is much like the often debated "free" colonoscopy. For many folks there is no such thing.

As soon as polyps are found it becomes diagnostic, not preventive , and your bill goes from $0 to $1000+

The doc can, and will, use anything at their discretion to upcode the bill.

A routine well visit is usually coded as 99213, but if the exam goes into more detail, often prompted by a patient complaint, the code can go to 99214.

The difference in the two exams is about $30 extra in the doc's pocket.

 

[leevena]

Lee, this is much like the often debated "free" colonoscopy. For many folks there is no such thing.

As soon as polyps are found it becomes diagnostic, not preventive , and your bill goes from $0 to $1000+

The doc can, and will, use anything at their discretion to upcode the bill.

A routine well visit is usually coded as 99213, but if the exam goes into more detail, often prompted by a patient complaint, the code can go to 99214.

The difference in the two exams is about $30 extra in the doc's pocket.

I agree completely. What I am saying is; 1) the patient said there was an issue (tired) as opposed to saying "nothing is wrong, just want my free check-up", 2) even if he said something was wrong, he could have refused additional services (costs) and, 3) why would the doctor risk the liability of changing the diagnosis.

 

[Crabcake Johnny]

This would be one of the reasons that MA is going with a global payment system for providers and moving away from "fee per procedure."

 

[taterpeeler]

I agree completely. What I am saying is; 1) the patient said there was an issue (tired) as opposed to saying "nothing is wrong, just want my free check-up", 2) even if he said something was wrong, he could have refused additional services (costs) and, 3) why would the doctor risk the liability of changing the diagnosis.

No lee... they cant refuse because the flipping is later sometimes. the same pap smear preventive and diag. is the same damn pap smear. i go in for a blood profile physical and because my BP wis a "tick" high because of white coat syndrom he flips the code... no its BS

 

[somarco]

the patient said there was an issue (tired) as opposed to saying "nothing is wrong, just want my free check-up"

Most patients aren't nearly as smart as you and won't tell the doc they just want the free exam.

even if he said something was wrong, he could have refused additional services (costs)

True, but most patients aren't as smart as you and few will question what the doc suggests.

why would the doctor risk the liability of changing the diagnosis.

Many times they won't. They don't want to risk an audit.

 

[Josh]

He asked for it to be coded differently but the doctor's office mgr said they could be sued for it...

If it was fraud, yes. If it was to correct a billing error, absolutely not.

 

[DS4]

Doing an office visit, several diagnostic codes can be applied. If the patient scheduled the visit as preventive, then that should've been the primary diagnostic code

 

[somarco]

If the patient scheduled the visit as preventive, then that should've been the primary diagnostic code

Depends on what happened after/during the exam.

Coding is done after the exam, not before.

 

[Norwayguy]

I agree completely. What I am saying is; 1) the patient said there was an issue (tired) as opposed to saying "nothing is wrong, just want my free check-up", 2) even if he said something was wrong, he could have refused additional services (costs) and, 3) why would the doctor risk the liability of changing the diagnosis.

Leevena, The typical patient doesn't know the ins and outs of what is and what is not Preventative. The Dr asked how they were doing that day. I asked every person I met today that question and they all took it for conversation that a diagnosis. The original poster left it at that. If all the Dr got was they are tired and didn't note that cause what is diagnostic about that?

I don't sell IFPs as Maine is GI without a market but this is what I complain about even a knowledgable buyer and someone asking questions about services would get tripped up by a question like that.

 

[dgoldenz]

I tell all of my clients going for preventative care visits to make sure the doctor notifies them if anything done during the visit will be charged for/diagnostic instead of what is covered 100% by their plan. Haven't had a problem with it yet.