Anonymous wrote:I remember a time when there was care in healthcare. This systemic “what’s in it for me” culture is unique to the DC area. You may find it elsewhere but not as prevalent.
If you move away you’re in for a pleasant surprise.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If they're related I only need one visit.

What they're trying to stop is someone coming in for the free yearly checkup and then bringing up major issues that needed more time to discuss.

But at a yearly checkup, I got a notice saying I couldn't bring up any problems. It's nuts.

Then you are better off using my dh's hack: go give blood and get a blood panel and vitals for free, walk in, no lab fee for blood test AND you get paid!

What do they check? Like cholesterol? Anemia Do they give you a print out of the results?

Anonymous wrote:So while we're trying to save the planet and reduce car travel and improve efficiency, the health sector wants us to maximize our use of time and resources.

It's like doing the household laundry by doing a separate load for each sock, shirt or piece of underwear.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If they're related I only need one visit.

What they're trying to stop is someone coming in for the free yearly checkup and then bringing up major issues that needed more time to discuss.

But at a yearly checkup, I got a notice saying I couldn't bring up any problems. It's nuts.

Then you are better off using my dh's hack: go give blood and get a blood panel and vitals for free, walk in, no lab fee for blood test AND you get paid!

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So while we're trying to save the planet and reduce car travel and improve efficiency, the health sector wants us to maximize our use of time and resources.

It's like doing the household laundry by doing a separate load for each sock, shirt or piece of underwear.

May I introduce you to telehealth appointments for acute issues? You may also be interested in combining an in-person urgent care visit in the same car trip with a Target run, then picking up your kid from swim practice. #planet

My acute issues generally require hospital based tests and extensive lab work, not Dr Zoom in Arizona prescribing a Z pack.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I would like to know if the providers on this thread talking about "insurance fraud" were born yesterday, or think that we were. Insurance fraud is billing insurers for services that aren't provided, or billing for more intensive services than were provided, or providing and billing for services that aren't necessary. There is no fraud involved with providing additional services during one visit. In fact, insurers almost always prohibit a provider from billing for 2 visits for the same patient in the same day. If the services can reasonably be provided in one visit, the insurer WANTS the provider to do that. And of course that's the case, because requiring the patient to come back another day costs the insurer more money.

No, this penny-ante BS is about providers generating revenues by billing as much as they possibly can. It costs insurers more, but ultimately it costs patients more, in increased premiums and copays. And it's terrible medical care. A good clinician should not be making it as difficult and inconvenient as possible for patients to get the care they need.

That said, PPs are correct that "wellness" visits are not designed for patients' needs. They're mostly an opportunity for providers to collect medical information, which insurers then use to justify raising premiums. At wellness visits, the goal is to hear about and record everything that's wrong with you, not to do anything about it. So if you want an annual check-up, make sure you are making an appointment for one, and not for a "wellness" visit.

1. Under coding is absolutely considered insurance fraud, just like overriding
2. There is no billing difference between an annual check up, a wellness visit, or a preventative care visit. They are all the exact same thing from a billing perspective. It doesn’t matter what you call it.

Avoidance of undercoding is a deliberate billing strategy. It is a letter of law reading of billing rules that deliberately skirts intent. This provides a great example of the phenomenon.

https://www.aapc.com/blog/26957-undercoding-is-no-better-than-overcoding/

"Nothing in the [Medicare fraud] document specifically talks about “down coding” or “under coding,” but if you read between the lines, you’ll recognize under coding as a compliance risk."

Actually, the document doesn't talk about it because Medicare doesn't consider it to be fraud.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It'd an insurance issue. They won't pay for 2 issues, only one

They won't pay for 2 *visits* to the same provider in the same day. That's not the same as 2 issues.

For non-procedural visits (check-ups, sick visits), clinicians bill for a visit, not for an issue. They bill what are called "evaluation and management" codes. Payment for these codes is based on either the length of the visit or the level of decision-making used. For evaluation and management visits, the reason for the visit is coded to provide evidence that the visit was medically necessary, and that the visit was lengthy or complex. The reason is NOT the basis for payment of evaluation & management visits.

So doctors *absolutely* can code a number of different reasons for a visit on a billing form. When they refuse to do so, it is because they want to bill for more visits. Sometimes that's legit-- they've already spent the time they've allotted for you and need to move on to the next patient. But sometimes it's because they're allotting an unreasonably short period of time to each visit or it's because they are refusing to bundle services together because they make more money by addressing just one of your issues at a time.

But then patients get mad when they are double charged for an appointment. Can’t win.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It'd an insurance issue. They won't pay for 2 issues, only one

They won't pay for 2 *visits* to the same provider in the same day. That's not the same as 2 issues.

For non-procedural visits (check-ups, sick visits), clinicians bill for a visit, not for an issue. They bill what are called "evaluation and management" codes. Payment for these codes is based on either the length of the visit or the level of decision-making used. For evaluation and management visits, the reason for the visit is coded to provide evidence that the visit was medically necessary, and that the visit was lengthy or complex. The reason is NOT the basis for payment of evaluation & management visits.

So doctors *absolutely* can code a number of different reasons for a visit on a billing form. When they refuse to do so, it is because they want to bill for more visits. Sometimes that's legit-- they've already spent the time they've allotted for you and need to move on to the next patient. But sometimes it's because they're allotting an unreasonably short period of time to each visit or it's because they are refusing to bundle services together because they make more money by addressing just one of your issues at a time.

But then patients get mad when they are double charged for an appointment. Can’t win.

Anonymous wrote:

Anonymous wrote:If they're related I only need one visit.

What they're trying to stop is someone coming in for the free yearly checkup and then bringing up major issues that needed more time to discuss.

But at a yearly checkup, I got a notice saying I couldn't bring up any problems. It's nuts.

Anonymous wrote:

Anonymous wrote:It'd an insurance issue. They won't pay for 2 issues, only one

They won't pay for 2 *visits* to the same provider in the same day. That's not the same as 2 issues.

For non-procedural visits (check-ups, sick visits), clinicians bill for a visit, not for an issue. They bill what are called "evaluation and management" codes. Payment for these codes is based on either the length of the visit or the level of decision-making used. For evaluation and management visits, the reason for the visit is coded to provide evidence that the visit was medically necessary, and that the visit was lengthy or complex. The reason is NOT the basis for payment of evaluation & management visits.

So doctors *absolutely* can code a number of different reasons for a visit on a billing form. When they refuse to do so, it is because they want to bill for more visits. Sometimes that's legit-- they've already spent the time they've allotted for you and need to move on to the next patient. But sometimes it's because they're allotting an unreasonably short period of time to each visit or it's because they are refusing to bundle services together because they make more money by addressing just one of your issues at a time.