Wow, upcoding

[tommie frazier]

the upcoding is all just part of the game. it's a shitty game, but it's the game.

they get squeezed on what they get paid for an office visit, then they figure great, they will bill for some questions that were asked or tiny things they did while looking at you. there are whole seminars and consultancies built around this.

the lack of transparency in pricing is a big problem. I don't want to ask my doc before everything I ask/they ask "will this answer cost me more money?" But maybe I shoud and we all should.

[dude cool]

Or we could get around all of these ridiculous shenanigans and just pay directly for primary care and other things that are routine and predictable. Primary care is actually very cheap if you cut out all of the extra admin of insurance. It's almost as if insurance used to only cover catastrophic, unlikely, random events for a good reason.

[Childish Gambino]

Originally Posted by dude cool

Or we could get around all of these ridiculous shenanigans and just pay directly for primary care and other things that are routine and predictable. Primary care is actually very cheap if you cut out all of the extra admin of insurance. It's almost as if insurance used to only cover catastrophic, unlikely, random events for a good reason.

Great idea. I'll start implementing it as soon as I get all this toothpaste back in the tube.

[LICENSED TO ILL]

Here is a fun upcode that I just witnessed.

The fee schedule for Oxygen states $.50 per unit. Well, the "unit" was supposed to be lbs. The provider figured out if they used PSI they'd be reimbursed more $. Been going on for about 9 months and a total of $320,000 of additional payments from the insurance company. I fixed the fee schedule to apply a different factor.

[Childish Gambino]

Originally Posted by LICENSED TO ILL

Here is a fun upcode that I just witnessed.

The fee schedule for Oxygen states $.50 per unit. Well, the "unit" was supposed to be lbs. The provider figured out if they used PSI they'd be reimbursed more $. Been going on for about 9 months and a total of $320,000 of additional payments from the insurance company. I fixed the fee schedule to apply a different factor.

Are you going to recoup the fraud? It amazes me he can't be thrown in jail for this.

[George Frankly]

Originally Posted by LICENSED TO ILL

Here is a fun upcode that I just witnessed.

The fee schedule for Oxygen states $.50 per unit. Well, the "unit" was supposed to be lbs. The provider figured out if they used PSI they'd be reimbursed more $. Been going on for about 9 months and a total of $320,000 of additional payments from the insurance company. I fixed the fee schedule to apply a different factor.

Did you find this out at work, looking at claims data? I mean, is it possible there’s more than $320k?

[exponentialpi]

Originally Posted by LICENSED TO ILL

Here is a fun upcode that I just witnessed.

The fee schedule for Oxygen states $.50 per unit. Well, the "unit" was supposed to be lbs. The provider figured out if they used PSI they'd be reimbursed more $. Been going on for about 9 months and a total of $320,000 of additional payments from the insurance company. I fixed the fee schedule to apply a different factor.

But, but, the insurance companies are the evil, greedy ones.

[PeppermintPatty]

Originally Posted by mathmajor

Update: I requested the two Dr. appts to be downgraded in severity. The Dr. herself emailed back and refused, offering that I can pay self-pay (for the first claim it's actually less) but questioning their codes will have me dropped as a patient.

Is that legal?

[PeppermintPatty]

Originally Posted by George Frankly

Holy hell. I know one provider (oncologist) who typically sees ~40-50 patients per day and I thought that was pretty bonkers.

Also, if you're curious, you can get a peek at which drug and device companies are contributing $$$ to your doc at this link.

I found 18 people with my doctor's name, but not my PCP.

[George Frankly]

Originally Posted by PeppermintPatty

I found 18 people with my doctor's name, but not my PCP.

Oh. That just means your doc failed their boards and isn’t a doc any more.

Seriously, I can’t find some of my physicians either. Maybe the database isn’t 100%, or maybe that implies your doc didn’t receive any money, although I seem to recall I did find some docs with $0 reported.