Did you happen to catch this New York Times Magazine article last month?
It begins with a moving story of an uninsured patient who suffers a terrible brain hemorrhage. Thankfully, she gets timely, effective treatment — but her condition requires many expensive services, including an air ambulance. Her bills totaled about $500,000.
Although the patient had assets like a vacation home and savings, the amount she owed was greater. As the article describes the patient’s profound stress in dealing with huge, unexpected bills while recovering, it seems clearly headed toward a case for single payer. However, it takes a rather astonishing twist along the way.
The twist? The piece proclaims that little-known villains are secretly contributing to skyrocketing patient bills and healthcare costs: medical coders. “The guerrilla tactics of providers’ coders,” the article argues, involve deliberately manipulating physicians’ codes — i.e., diagnosis codes — to create higher bills.
If you are a practice manager, biller, coder, or independent physician reading this for the first time while sipping your coffee, perhaps you just spit it out in shock (like I did). Because while there may be billers and coders out there who have been urged to make up diagnoses to generate higher bills, I’ve never encountered one. I can only imagine “guerrilla coders” are exceedingly rare. The billers and coders we work with have enough to do just trying to get their physicians properly paid for the work that they’ve actually done (!).
Physicians, billers, and coders have to work with the codes our entire industry uses to determine payment based on services rendered. If they aren’t careful and don’t check that all services are properly coded, practices (and hospitals) will receive less than payers have promised them for the work that they do. This is the problem billers and coders are trying to solve: Making sure their physicians and organizations aren’t underpaid for services performed.
That a trusted voice like the New York Times is promoting such a sinister impression of medical coding (among other inaccuracies in the piece) really bothered me. But something else bothered me more. Among the nearly 1,000 comments, hardly any stuck up for coders’ integrity or in any way questioned the idea that medical billing is nothing but an elaborate scam designed to cheat patients. The comments were revealing and discouraging — and also a warning sign.
As deductibles continue to climb and practices need to collect more of their earned revenues directly from patients, distrust of the process only makes that task harder. Medical bills can be extremely confusing, even to those of us in the field, especially when multiple entities are involved. Receiving a large bill you don’t understand is unsettling to say the least. Confusion alone may cause patients to hesitate to pay. But when an institution like the New York Times implies that you’re using “secret language” and “guerrilla tactics” to inflate medical bills, suspicion is fostered. That suspicion could make patients more likely to pay slowly, or not at all. Suspicion of the billing process could even undermine patient relationships and engagement.
Practice staff really shouldn’t have to be on the front lines of explaining insurance terms like “deductible” and “coinsurance” or helping patients understand their bills. Patients should get much more education and help from their insurers and benefits departments. But the fact is, they don’t — and that leaves the task to you and your staff. If your practice doesn’t tackle the challenge of educating patients about their payment responsibility, you’re less likely to be paid all of what you’ve earned. And if ideas like “the guerrilla tactics of medical coders” take root in the absence of real information about the process, patient billing confusion may even harm your physicians’ relationships with patients.
The importance of preparing patients to pay and adjusting your workflow accordingly is a subject I’ll touch on in my upcoming webinar with @gokareo, “Navigating a New Era of Patient Collections,” at 10:00 AM Pacific on April 26. It’s free, and I hope you’ll join me! (If you can’t make the live presentation, register and you’ll be able to view the recording.)