billing

[chessknt]

I am aware. I guess the point of "monitoring normal labs daily" was missed. we don't need a consultant to say "continues to be normal" daily. I certainly don't consult nephrology to be there "just in case" labs become abnormal or hematology "just in case labs become abnormal" nor have I ever seen a colleague do that

But you don't work inpatient medicine right? You don't routinely take care of patients with PICS that are still hospitalized so you don't really know what a routine behavior is in that population. A lot of this is determined by local culture but generally speaking survivors of critical illness are high utilizers of resources. They can get very sick again quite easily and are fragile; having a specialist following a specific organ system helps the primary team if they have a census of 30 people because that means instead of responding to a normal Na that has dropped from 144 to 130 over 3 days the nephrologist can identify volume overload on day 1 or 2 and intervene before there are more serious consequences.

Just an example but if the local cx is to have big censuses or the hospitalists suck th n specialist care is going to elevate recovery, not just the bill even if it is seemingly doing nothing.

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[Iamnew2]

But you don't work inpatient medicine right? You don't routinely take care of patients with PICS that are still hospitalized so you don't really know what a routine behavior is in that population. A lot of this is determined by local culture but generally speaking survivors of critical illness are high utilizers of resources. They can get very sick again quite easily and are fragile; having a specialist following a specific organ system helps the primary team if they have a census of 30 people because that means instead of responding to a normal Na that has dropped from 144 to 130 over 3 days the nephrologist can identify volume overload on day 1 or 2 and intervene before there are more serious consequences.

Just an example but if the local cx is to have big censuses or the hospitalists suck th n specialist care is going to elevate recovery, not just the bill even if it is seemingly doing nothing.

The hospitalist does suck and doesn't know much. He has consulted more specialists than he was even seeing in the ICU despite being perfectly stable now.
I do do inpatient medicine. Many of my patients have PICs, PEg tubes, IV antibiotics, serious wounds, etc. I manage many things and consult when appropriate - I don't consult everyone for every little thing. I think the hospitalist just doesn't want to bother.

 

[Iamnew2]

You're conflating several things here.

My point is about billing in terms of dollars and cents not whether people are using the right billing codes.

I'm outpatient primary care, probably 80% of my office visits I bill a certain code (99214 if you care) which is a moderately complex encounter. My employer has assigned a value to that specific code. Let's say its $300. So a patient's bill will have the $300 charge on it. But, the hospital knows full well that their insurance won't allow us to charge that much so you get a "contractual adjustment" that brings the charge down to usually around $150.

That's what happened in your original scenario. The anesthesia billing people charged you $5400. Your insurance contract with that group said that the maximum charge was actually $650 per your previous post. The insurance paid $600 and you paid $50. So while you were billed for $5400, everyone involved except apparently you knew that you wouldn't be on the hook for that much.

of course i knew i woudln't be on the hook for $5400 - but the charge itself is obscene. Had had surgery on a number of occasions and have never had such an outrageous anesthesia bill - if there was no insurance they would have expected that obscene amount.
And they couldn't even tell me how they billed that and how the amount came out to be - if I send a patient a $10k bill for an epidural and the patient says oh how did you get to that number? And my biling people are like oh well that's just the bill, we billed you correctly and can't explain how i'm sure the patient would be pissed.
But will leave it at that Dr. VA Hopeful! Have a good weekend.

 

[VA Hopeful Dr]

of course i knew i woudln't be on the hook for $5400 - but the charge itself is obscene. Had had surgery on a number of occasions and have never had such an outrageous anesthesia bill - if there was no insurance they would have expected that obscene amount.
And they couldn't even tell me how they billed that and how the amount came out to be - if I send a patient a $10k bill for an epidural and the patient says oh how did you get to that number? And my biling people are like oh well that's just the bill, we billed you correctly and can't explain how i'm sure the patient would be pissed.
But will leave it at that Dr. VA Hopeful! Have a good weekend.

Not generally. Usually uninsured patients get a pretty good cash-pay discount. My system offers 40% off, usually with an additional 10% if you pay within 30 days.

 

[sloh]

The hospitalist does suck and doesn't know much. He has consulted more specialists than he was even seeing in the ICU despite being perfectly stable now.
I do do inpatient medicine. Many of my patients have PICs, PEg tubes, IV antibiotics, serious wounds, etc. I manage many things and consult when appropriate - I don't consult everyone for every little thing. I think the hospitalist just doesn't want to bother.

We are both PM&R and as a fellow PM&R doc I would say acute inpatient rehab patients are way more stable than patients on the floor. Try to lend the specialists and hospitalists some slack here.