Urgent Care Costs?

[disneysteve]

Also, for billing purposes, the extent of the physical exam is part of what goes into determining the code for the visit. I'd have to check but I'm not sure if a visit that involved absolutely no physical exam can even qualify as a 99214

So a physical exam is not required to justify the code. The 3 criteria are History, Exam, and Medical Decision Making, but only 2 of 3 are needed.

[disneysteve]

I've worked in hospital billing for over 10 years. Any time a code needed to be changed, it had to be done by medical records.

Interesting. I would never have thought that the records department would have any say in the coding. Any time I've had a billing issue personally, I've handled it through the billing department or through the provider's office directly.

[msomnipotent]

Interesting. I would never have thought that the records department would have any say in the coding. Any time I've had a billing issue personally, I've handled it through the billing department or through the provider's office directly.

Depending on the size of the office, there could have been someone in the billing department that was able to change codes, but ours did not. Once the bill was cut, the codes were considered part of the medical history, so the medical record would need to be changed. Whenever I got a call about changing a code, I had to go through medical records to get it changed and then get back to the patient. I wouldn't trust just a billing dept to handle it. Our main qualifications for getting the job were 1. Do you speak English? and 2. Can you pick up a phone when it rings? The medical records dept had a lot more training. The larger the facility, the more specialized the departments are. I used to work in a dept that did nothing but call insurance companies all day just to make sure the patient had insurance.

[TexasHusker]

I've spoken to our director about it and he agrees that we should be able to have a simple price list for how much a strep test or flu test or tetanus shot or chest x-ray is going to cost a cash patient. I'm still waiting for that list.

Your director's bosses aren't going to agree to that, because they don't want anyone to know what they actually charge: They're ashamed. This is the current game of healthcare finance: The charge usually has little to no relationship to the actual cost of the underlying service/procedure/item.

In businesses where the end user is involved in the transaction, there is usually some sort of rational mark-up formula. Walmart might mark up their shirts by 3 or 4 times. A furniture store might mark of each piece by 100%, maybe more.

In healthcare, it's not uncommon to see things marked up 10 to 20 times, maybe even 100 times. A hospital will buy an implant for $10,000 and then mark it up to $30,000 with no problem at all. The poor consumer who doesn't know better pays it, or makes arrangements to do so. Don't have the cash to pay? They'll set you up to pay for the rest of your life, and then file a property lien against your estate on the balance when you're six feet under.

It is truly the wild west with no sheriff. I am normally a "free market" capitalist, but the gubmit has so screwed up healthcare and higher education that they just need to quit playing games and take the things over in their entirety.

Perhaps that was their endgame to begin with, but that's probably what needs to happen now.