Jeff is reclaiming his unique digital identity with a sense of clarity.

healthcare

http://youtu.be/2qurHn4KVnw

I’m trying to help spread the word about this since it’s about my cousin and a very good cause.

Jon Thomann was injured a couple of years ago, and was in a coma for several months. He finally got back to walking, but he still has a limp and is very unbalanced. He’ll never be the same but at least he is alive. Jon’s father, Joe is working on trying to raise money to get this started in Mid-Missouri. They’ve raised about a third of the money they need, but still have a long ways to go.

Here’s the link to the article on the KOMU site: http://www.komu.com/news/family-pushes-to-bring-brain-injury-center-to-columbia/

Here’s the link to Jon’s caringbridge site: http://www.caringbridge.org/visit/jonthomann/

If you want to help with the center itself, the donation on the caringbridge site listed above is not for the center – that’s for caringbridge donations, which is a good cause too…. The center’s website is http://www.headinjuryctr-stl.org/jeffday.html

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MU Healthcare tweets

I’m adding yet another twitter tweeter in to this blog…
MU Healthcare tweets in here are coming from
http://twitter.com/statuses/user_timeline/45928911.rss


A few Typical Health Insurance Denials… and some steps you can take to help them from affecting your payments…

A few Typical Health Insurance Denials… and some steps you can take to help them from affecting your claims…

Pre-certification penalty/no prior authorization denials/Percertification Problems Denial

A precertification Penalty is is an amount that an insurance will apply to your repsonsibility if you, or the healthcare facility that you are staying at (hospital, etc), did not take the proper steps to obtain pre-certification from your insurance. Ultimately, obtaining prior certification is YOUR responsibility. Therefore, even if the healthcare facility that you are staying at claims to have an authorization on file, you should probably call your insurance to verify that this is true, and that the authorization in question does apply to the actual surgery or other service that you are going to have done.

Sometimes, if this sort of denial is issued on your claim, you or the healthcare facility can file an appeal with the insurance requesting a retroactive authorization be issued that can be used in place of an a prior authorization. However, be prepared to send Medical records since most retroactive authorziation reviews require that medical records be submitted to the insurance before any attempts will be made to do a review of the claim for reto-authorization. Additionally, some insurances will refuse to issue any retroactive authorization at all and claim that a prior authorization should have been requested PRIOR to the services being rendered. It really depends on the insurance in question and charges in question as to whether a reto-authorization can be issued.

A pre-certification problem denial is similar to a pre-certification penalty but is usually associated with only part of the charges that the insurance is questioning. In cases like this, most or part of the charges on the claim in question are paid but some charges are not paid, and the insurance usually needs more information from the healthcare facility, including, but not limited to medical record information, in order to consider payment on the portion of the charges that were denied.

A no-precert penalty is similar to a pre-certification penalty, or a pre-certification problem denial but typically causes ALL charges to be denied instead of only part of the charges. These sorts of denials can become a big problem over time in certain cases, since YOU may be ultimately responsible for 100% of the charges. Of course this depends entirely on the reason for the denial, if the claim is appealable by the healthcare facility, and is really dependent on case by case information since all cases are different.

No Primary Care Physician Referral Denial

A non-referral denial is similar to a no-precert denial except that it applies to not having a referral from your primary care physician on file with the insurance. Some insurances require referrals to see specialists, and others do not. Please check your insurance policy to see if you need a referral since, as with prior-authorization denials, YOU might be ultimately responsible for payment on no-referral denials.

Timely Filing Denials

Healthcare facilites have a certain timeframe to submit claims that varies greatly depending on the insurance in question, the state in question, and a number of other issues. If the facility waits too long to submit a claim, insurances sometimes deny the charges in question for timely filing. Usually, if it’s the facility’s fault for not submitting the claim, they will have to just take the hit, and not receive payment. However, if you are at fault for some reason, such as not presenting your insurance identification card to the facility at the time of service when you were seen, or you did not give the facility a copy of your insurance information until too late for them to submit the claim in a timely manner, the facility is within it’s rights to bill you for 100% of the charges. For this reason, IT’S ALWAYS IMPORTANT that you present your insurance ID Card to whatever healthcare facility you go to. Your doctors, hospitals, and anyone else that treats you medically really needs to know your insurance information so that they can bill your insurance in a timely manner and not hold you responsible for all charges… Sometimes, it is possible to appeal a denial for late claims, but usually, late claim denials can not be overturned unless there is a really valid reason that the insurance will be ok with.

Billing Issues

Sometimes insurances deny claims because they don’t believe that the claim was submitted properly, and they may dispute something on the claim with the facility. Typically this is an argument that the facility and insurance has to battle out between one another because it usually involves interpretion of contracts, laws regarding how things are suppossed to be billed, and other similar issues. If one of your claims, or some of the charges on it ever get denied for something like this, ask as many questions as you can to both the healthcare facility and your insurance so that they can work out the problems as soon as possible and not hold you accountable for something you should not be held responsible for.

Documentation Denial/Medical Necessity

Sometimes insurances deny some or all charges on a claim for need of more documentation. Sometimes this can be as simple as needing a copy of an ER report, itemized statement of charges, or something else out of your medical record. Sometimes it’s due to something the insurance wants directly from you, such as a copy of an accident report from the police, a copy of other insurance information for whatever other insurances you might have, or some form that explains that you don’t have other insurance, etc. Somtimes it’s a lot more complicated than that. If you ever find a denial for need of documenation on your claims, be sure to give the insurance and maybe even your healthcare facility a call to see what additional information is needed, and what steps need to be taken to resolve the issue. Sometimes, the insurance might actually have the needed documentation on file already, but just needs a call to verify this so that they can reprocess the claim(s). Sometimes, for Medical Necessity denials, the insurance just needs a letter from the physician that explains why the charges in question were medically necessary. Always ask questions when you are not certain about why charges are being denied. Many times, documentation denials and medical necessity denials can be overturned with a little bit more information being fed to the insurance by either you or your healthcare provider.

Non-Billable Charges/Non-Covered Charge Denial

Some insurance policies will only cover certain charges. Usually if there is a denial for this sort of thing, you can check your policy and see if the charges of this type are or are not covered by your policy’s benefits. Always be sure to ask the insurance for clarification on something they deny that you do not understand since the processors are human, and prone to human errors on occassion… Many times this sort of denial is applied for certain exclusions to a policy. For instance, your health insurance might not pay for pregnancy of your dependent, etc. Always be sure to read your policy and ask as many questions as you can. It’s good to know what is and is not covered before you go in to see a doctor, have a surgery, etc. so that you can be financially prepared for whatever charges the insurance won’t cover due to some limitation of the plan.

Out-Of-Network Denial

Many insurances have networks of hospitals and doctors. If you see a doctor or go to a hospital in the network, services are paid. If you go to a doctor or hospital out of the network, charges may not be covered, or might be paid at a lesser rate that causes you to be responsible for payment on more of the charges than you would have to pay if you saw an in-network provider of healthcare services. Be sure to check ahead of time that the hospital or doctor that you are seeing is in-network. In emergency situations, sometimes insurances can and will pay in-network rates for out-of-network providers. It all just depends on the insurance in question, their internal policies, and your insurance policy with them. Always ask questions to your insurance if you do not have a clear understanding of something. Also, be sure to ALWAYS give your healthcare provider a copy of your insurance ID card since network logos are sometimes on the cards, and those are useful in helping the facility seek proper payment from the network in question as different networks might pay different rates, or the card might be able to prove that you are in network when the insurance denied the claim saying you were not in network.

No Coverage on Date of Service Denial

This sort of denial is issued when an insurance denies coverage because it believes your policy with them was not active on the date of service. The main times this sort of issue comes up is during extended hospital stays when the insurance coverage stops in the middle of the stay, when a stay extends from December to January and coverage under the policy stops on December 31st, when COBRA is involved but the claim was billed as non-COBRA, or when insurance in question is a special circumstance type of insurance such as Work Comp, an insurance that only covers individuals in prison, only covers a certain population – such as people with aids, etc. However, this sort of denial can really happen in almost any circumstance. If your claim gets denied for this reason, be sure to ask questions to both your healthcare facility and you insurance. Sometimes this sort of denial could have come about from something as simple as the hospital submitting a claim with your old insurance ID number and now they need to submit a claim to the insurance with your new insurance ID number, etc. Sometimes it’s a lot more complicated than that, such as your employer disputing coverage on a work comp case that you believe should have been covered, in which case you ultimately may need to seek legal advice to help get the bill paid. Always ask as many questions as you can to seek clarification on why some or all of a claim is not getting paid if it’s not getting paid.

Certification of Benefits Denial

Many insurances request certain inforamtion from their members about other insurance information, proof of school status, and other such details about once a year. If your insurance requests this sort of information from you, please provide the needed information to them as soon as possible so that your healthcare claims don’t get stuck being non-paid because you did not provide enough information to your insurance to allow you insurance to pay your bill. In cases where claims get held up for this sort of reason, many healthcare providers will hold you responsible for 100% of the charges on a claim, and sometimes even send you to a collection agency seeking payment for the claim. Always make sure your insurance has the information that it needs to get your claims processed.

Coding Problems

Sometimes insurances deny claims for need of better coding on a claim. Usually this sort of issue is something that needs to be resolved between the facility and the insurance as it typically involves interpretation of standard practices, contract language, state laws regarding billing, and possibly federal laws regarding billing. Many insurances can and do try to deny claims for coding issues when the claims in question are billed 100% accurately, and the insurance processor did not have a clear understanding of updated laws or regulations about billing that enables them to understand why the claim was coded a certain way. Always be sure to ask as many questions as you can to both your healthcare facility and insurance when a claim gets denied for these sort of reasons. Sometimes the facility is at fault for actually not billing something correctly. Other times the insurance is at fault for not understanding the reason why a facility billed something a certain way. In most cases, you should not be held responsible for coding problems.

Continuation of Stay Issues

Sometimes insurances deny the last day(s) of an inpatient stay, or other facility charge that extends for a number of hours or days beyond what the insurance believes should have been the total length of the stay. Many times, facilities can prove that the extra length of time is justified with proof of medical necessity. Other times, the facility cannot prove that the extra length of time was justified. In all cases where a denial of this sort happens, you should probably request your healthcare facility explain the medical necessity reasons for the extended stay to the insurance so that the insurance can review the facts and determine if additional payemnt is needed.

Cosmetic Surgery Denial

Sometimes, insurances automatically deny anything they believe might be a cosmetic surgery because they believe that the charges in question are not covered by your insurance policy, or that the charges were not really medically necessary. However, in many cases, the charges for surgeries such as facial reconstruction, botox treatments, etc. are needed for a variety of reasons that ARE medically necessary (for instance, perhaps you need a nose reconstruction because it was damaged in a car wreck, a botox injection was given to help relieve pain in a certain area – i.e. it was a bit of a muscle relaxer/pain reliever, etc.), and the healthcare facility can sometimes prove this to the insurance by submitting an appeal on your behalf and/or requesting that the doctor that performed the surgery submit a letter to the insurance on your behalf explaining why the surgery in question was medically necesary. Whenver a claim is denied as being medically un-necessary, it is probably possible to submit an appeal and get additional payment unless you are sure that the charge in question was not really medically necessary and is not covered by your insurance policy (for example you got a face lift or tummy tuck just because you felt like you needed to look better and wanted to look more physically attractive even though your insurance policy specifically says they will not cover charges of this sort)

Alchohol/Substance Abuse

Sometimes insurances won’t cover hospital or doctors bills that come about due to intoxication. This varies from plan to plan and circumstance to circumstance. Sometimes charges denied for this can be appealed and additional payment is issued by the insurance as a result. Other times, the charges will remain denied since the policy won’t cover the charges in question. Be sure to check your policy to see if it limits coverage for this sort of thing. Also, be sure to be responsible when you drink! NEVER DRINK AND DRIVE! Also, if a third party was responsible for your being hospitalized because they were intoxicated and crashed in to you or something, be sure to ask questions to your healthcare facility and insurance about if the third party will be held accountable for paying your hospital bills. Sometimes, in cases like that, you should seek legal advice…

Mental Health Denial

Some medical insurances deny any charges that are related to mental health because their policies don’t handle mental health and/or there is a mental health insurance that claims related to mental health should be submitted to. However, sometimes this sort of denial is done in error as the charges in question are really medical and not mental. Always ask questions to your insurance, healthcare facility, and possibly even your employer when you receive a denial of this sort to make sure that the correct insurance is being billed and that that insurance will cover the charges in question.

Dental Insurance Denial

Similar to the mental health denials, some medical insurances won’t cover dental related charges. However, in some cases, such as when you are in a wreck and a healthcare provider has to do a surgery to fix something in your mouth immediately to keep you alive, this sort of denial should not be denied and might be appealable so that the insurance can issue additional payment. As with all other denials, make sure to ask questions for clarification as to why the denial is being issued, and if the denial is appealable, or was issued in error.

Discount Error

Sometimes insurances pay the wrong rate for a facility’s claim. If you see the incorrect network discount on your Explanation of Benefits (for instance the insurance took a discount through a network that you know for a fact is not a pricing agency for your insurance), it might be a good idea to call your insurance to see if they need to reprocess the claim. Many insurances utilize multiple networks, and may sometimes pick the wrong network to price a claim. This can affect how much you owe. For instance one network might allow for a 30% discount and another may allow for a 20% discount, leaving you to pay more in your deductible if your deductible is based on a percentage of charges. A 10% difference may not sound like a lot, but if you have a hospital bill worth thousands of dollars in total charges, that can add up fast.

Multiple Dignosis Denial

Some insurances will deny some or all charges for certain diagnosis. If you receive a denial from an insurance, ask the insurance for clarification about why the charges in question are being denied, because sometimes denials are issued in error.

Duplicate Claim Denial

Sometimes insurances deny charges if they receive a bill from the same facility for the same date of service, where there are more than one bill on the same day. Sometimes this sort of denial is valid because the billing department at the facility may have messed up and created two claims when only one was needed. However, other times, this sort of denial can be overturned since you may have legitimately had more than one office visit at the same place in one day. For instance, some people that live far away from a hospital might come in to a hospital with clinics in it and go see one place for an eye exam, another for treatment of flu symptoms, and also have an x-ray done for follow up on a broken bone on the same day, etc. Also, sometimes someone may go to an ER, be released, only to come back later in the day after they have an additional accident or new untreated symptoms arrive, etc.

Emergent/Urgent Care Denial

Some insurances will deny emergency or urgent care charges if they believe the charges in question are related to a diagnosis that they believe did not require emergency care. Sometimes denials of this type can be overturned since the charges in question actually did require emergency care, as the claim itself that was submitted to the insurance did not give the insurance the full picture of what all was going on. In cases like this, sometimes, and appeal with some information from the medical record can overturn the denial and get the claim paid.

Experimental Service Denial

Some insurances deny some charges as being expermental becuase the Amercian Medical
Association, or some other group does not have a lot of information on use of this type of treatment for this type of problem. Sometimes these sort of denials can be overturned. Other times they cannot. Additionally, sometimes, the healthcare facility in question will accept non-payment on certain charges like this since the charges in question actually were experimental.

Maximum Benefits paid for Policy Issue

Some policies have a lifetime maximum payment amount or a yearly, or even daily maximum payment amount. Usually, once the maximum has been reached you will be held responsible for 100% of the allowable charges (all charges left after the network discount is applied). Sometimes, in some rare cases, the maximum policy benefits were not really reached when the bill in question was paid, so the insurance might be able to get some more paid on the claim if you appeal the claim to them asking for further payment. Also, some facilities might be able to do additional discounts for you if the charges in question that you are responsible for if you promise to pay a certain amount in a certain time frame. Ask questions any time something is denied since it might be possible to squeeze more money out of either the insurance of the facility to cover all or some of your portion of the charges.

Financial Aid

Some healthcare facilities do write-offs for some individuals who cannot issue payment in some circumstances regardless of whether they have insurance or not… Also some will take a patient responsibility discount if you issue payment to them in a certain speeded up timeframe. It is possible to do some level of negotiation with both the insurances and healthcare facilities in some cases. However, you won’t ever know much about that sort of thing unless you ask the right questions to the right people. Always be involved in your own healthcare, and ask as many questions as you can, both about your actual medical well being, as well as your financial well being. The only dumb question is one that is never asked but that should have been.

Be Proactive. Be healthy. Be wealthy, and be wise.


It’s scary how unsafe our healthcare data can be these days!

Scary stuff…

http://www.modernhealthcare.com/article/20091209/REG/312099987

Lisa Gallagher, senior director of privacy and security at the Healthcare Information and Management Systems Society, presented results of a survey at an HHS-sponsored advisory panel on standards in November. Fifty-two percent of large hospitals, 33% of mid-sized hospitals and 25% of small hospitals surveyed reported experiencing a data breach in the past year…

http://www.muhealth.org/documents/compliance/Word_Documents/December2009.pdf

——————
In October and November, a slew of healthcare organizations announced patient data losses, including:

• Aurora St. Luke’s Medical Center: Over the weekend of Oct. 9-11, the office of hospitalists employed by Cogent Healthcare was burglarized in a building adjacent to Aurora St. Luke’s in Milwaukee, according to hospital spokesman Adam Beeson. Taken was a laptop computer with billing information on 6,400 people, mostly Aurora hospital inpatients, that included in almost all cases, names and diagnoses, and in some cases addresses, medical record numbers and Social Security numbers, Beeson said.

• Blue Cross Blue Shield of Tennessee: In its Chattanooga office, 57 hard drives were stolen early in October from servers being used for training, according to a plan spokeswoman. The drives held copies of 300,000 computer
“screens” pulled up during customer service interactions along with recordings of 50,000 hours of telephone conversations about patient care and medical bills, according to the health plan. The data included names, addresses, dates of birth and, in some cases, diagnoses.

• Children’s Hospital of Philadelphia: On Oct. 20, an employee had a laptop computer stolen from a car parked at home; the computer contained the Social Security numbers and other personal information of 943 people, hospital
spokeswoman Juliann Walsh confirmed last week. Walsh said the hospital is providing the affected parties with identity theft monitoring, consultation and restoration services,

• Harris County Hospital District: Sixteen employees were fired for alleged violations of patient privacy laws involving the records of a first-year resident, according to a district official. The Houston Chronicle reported that the workers were fired Nov. 20 for looking at the medical records of a first-year Baylor I College resident assigned
to Ben Taub General Hospital, Houston, according to the Associated Press.

• Health Net: Sometime in May, a hard drive disappeared from the Shelton, Conn., office of Health Net, an insurer based in Woodland Hills, Calif. According to Connecticut Attorney General Richard Blumenthal, the drive contained health information, and financial and personal data, such as Social Security numbers, on 446,000 Connecticut patients. According to Blumenthal, his office was not notified of the breach until Nov. 18, about the same time as plan members. Blumenthal said his office was investigating.


A few healthcare tips…

As someone who works for a hospital, in a Department that works closely with insurance contract interpretion, I’ve seen a lot of behind the scenes sort of things that a lot of people don’t necessarily think about when thinking about their hospital and doctor bills – things that might be costing them a lot but that they are not aware of, costs both in healthcare being provided to them as well as monetary costs…

Here’s a few tips related to healthcare that you might want to keep in mind in the future when dealing with your insurance company, hospital, doctor, or any healthcare provider. I’ll probably post more tips in future postings as I think of new tidbits. I’ll try to keep this as specific as I can so that it’s useful information for the general public but as unspecific as I can so that I don’t get in trouble for HIPPA violations or get in trouble with my boss if anyone I work with ever stumbles across this in the future.

Reciepts…
Always ask for a receipt any time you pay a bill. Sometimes clerical errors can cause bills to continue to be sent to patients by a hospital after the bill is sent. Other times, it’s possible that the bills are being computer generated by a system that is automated, and it’s impossible to turn the system off if a bill comes in… In many cases, at some healthcare facilities, hospital bills DO get sent to patients after the bills are already paid, and in some cases, those bills will have a date on the top of them that indicates that they were produced AFTER the payment for the bill has already been paid by the patient. This usually happens because of the fact that many hospitals, doctor offices, and other healthcare providers outsource some or all of their billing, and/or rely on billing systems that are not able to always be 100% up-to-date. In some, rare cases, this could be considered fraud because the bills are being created after the claim in question is already paid, making it highly confusing to patients, who sometimes send in payments any time they receive a bill, resulting in overpayments.

Overpayments… and Small Dollar Writeoffs…

Many healthcare facilities, and some insurance companies as well, typically write off small dollar debits and credits below a certain amount. For instance some hospitals might write off debits and credits below a fifteen dollar amount, and some physician offices may write off debits or credits with values around five or ten dollars. The actual amount varies from place to place, and office to office. What is important to know about this is that this means that they are likely going to write off a certain amount of money up to a certain dollar amount if it is either OVER or underpaid. For underpayments, this can work to your benefit since it might mean that you are getting away with not paying your copay, etc.

However, As mentioned in the above paragraph on Receipts, that might mean that your overpayment on bills that you’ve already paid are being written off and you’ll never be refunded for the amount you overpaid on your bill if it’s an overpayment amount under the threshold that the facility in question is using to determine writeoffs. You would think that it would be unethical for healthcare facilities to keep your overpaid money, but they don’t think twice about it because they have deemed the amount below that threshold, whatever amount it’s set at, to be not worth their time since it’ll cost them more in paying their staff to refund you the money than the actual refund itself is worth. This can really add up over time, since some people may put off going to the doctor for many months, and then go and see several doctors in clinics in a hosptial all on one day – resulting in multiple bills for the same day…

For example… If a hospital has a 15.00 small dollar write off, and physicians at the same facility have a 5.00 writeoff policy that is similar… 15.00 overpayment could be being thrown away in a write off for one bill, and another 5 for the physician bill that’s for the same service… for a total write off of 20.00 overpayment for one clinics for one day… maybe one for diabetes, one for an eye exam, one for a follow up on something else, and a couple of others for various other problems… Lets imagine what could happen if you saw 5 clinics on the same day, and got an x-ray or mri too, both of which could result in additional bills… That could be 7 or more hospital clinic bills, and 7 or more physicial bills since the physicians and hospital send out different bills… You could have possibly overpaid 20×7 = $140.00 in total for just that one day… and never have a chance of getting it back since they consider it written off as a small dollar amount that they don’t want to mess with… Imagine how much money you could be loosing in something like this if you have ongoing problems such as chemo treatments, diabetes, or any other numerous health related issues that require ongoing visits?…

Make sure to ask what the small dollar write off policies at the facilities you deal with are. Also, be sure to always ask as many questions as you can think of related to your bill so that you know what is going on with your money.

Applying Overpayments…

Similar to the issues mentioned above, some facilities tend to move money around on various bills that a patient has where they see fit. In other words, if you overpay a bill one month, and you incur another bill the next month, some facilities will apply the payment up to the amount owed, move the overpayment and apply that overpayment amount to the next bill that still has a balance, resulting in a very messy accounting of where the money you paid was actually applied, and also making it very confusing to know if you have overpaid anything or still owe money on something. This typically happens if you pay a copay or coinsurnace payment to a healthcare provider at the time that the service was provided, and then later, after your insurance is billed, it’s discovered that the insurance paid your bill in full, and there was no actual balance you should have paid in the first place, or the insurance has left you with a copay, deductible, or coinsurance amount that is smaller than what you paid at the time of service. Make sure you know your benefits, and are kept updated with changes, and know exactly how much to pay when, if possible.

Discounts

Many healcare providers and insurance companies have negotiated contracts between one another so that the insurance company can pay a smaller amount than 100% of the charges billed by the healthcare facility, and the payment with that discount makes the payment considered to be “paid in full” by the healthcare facility. These managed care contracts can be very confusing, and often can be interpreted in a number of different ways by a number of different parties, depending on how the contracts themselves are worded. Many of these contracts also have new amendments, negotiations, etc made to them yearly, or on some sort of regular basis. Make sure to check all explanation of benefits that your insurance company sends you to make sure that you only paid the amount that you should have to the healcare provider. If you paid the amount that should have been discounted, request your money back.

Some facilities will work with uninsured people, or people that have out-of-network benefits at a particular facility that they go to (out of state provider that specializes in something that a place more local cannot handle, etc.). Similarly, some facilities are willing to negotiate with under-insured people, such as Amish communities, Church groups, people who have no health insurance that are willing to pay a certain percent of the bill immediately, etc. Make sure to ask as many questions as you can think of to both your insurance company and healthcare provider to make sure you are not overpaying on something that should have been discounted.

Medicare… and other Governement Programs can be very odd sometimes…

Did you know that Medicare pays a flat Diagnosis Related Grouper (DRG) rate on inpatient claims? They also pay something called an outlier in addition to that if the amount billed is high enough and falls in to certain conditions. What is very important to understand about this is that sometimes, the flat DRG payment rate is MORE than the amount that some healthcare providers charge. In other words, if a DRG rate is something like $1500.00, and the hospital is only charging $1200.00 for the bill, Medicare is paying the hospital $1500.00, and this is considered to be legal since Medicare paid the DRG rate. What is even more odd about this sort of thing is that even though the hospital is getting paid more than it’s billing, they can still legally hit you up for even more money in addition to this because you still legally owe your copay or deductible amount… In other words the hospital is getting paid more than it’s charging and you are still on the hook for more money than that. No wonder the folks in Washington are trying to reform Healthcare. Tricare (the insurance for our armed service men, and retirees) is set up very similar to Medicare. In addition some insurance companies use Medicare as a bases for establishing the amounts they pay… so in the past some commercial insurance companies have been known to pay hospitals more than the hospital charged for certain services, due to the fact that the insurance(s) in question were paying based on flat DRG rates, in contracts that did not have a “lesser of DRG Rate or total billed charges” clause in it – and patients still were getting billed copays in addition to this payment over the total billed charge amount… Ask as questions to both your insurance company and healthcare provider(s). Things can and are confusing sometimes…

Scanning money…

It is illegal for healthcare facilities, insurances, or anyone else to scan paper money at 100% of the original size of the money in question. Doing so is considered by the United States Government to be counterfitting. In the past, some healthcare providers have scanned dollar bills as proof of payment for some low dollar copays. If you ever see anyone scanning money, ask them why they are doing that, where they are saving it, and at what size they are saving it or printing it. Some newer software, such as Adobe Photoshop, will actually try to not save scanned money. It is legal to scan money, so long as certain rules are followed, so Adobe actually is going a few steps too far in completely stopping the scanning of money. http://www.ustreas.gov/usss/money_illustrations.shtml

more posts will likely come in the future about healthcare…