Do ER docs choose how much they bill?

[airuike]

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I'm thinking about going to medical school and I like the idea of working in the ER, but I have to ask: Do ER docs decide how much patients get billed? I think if I were a doctor, I'd like to be well compensated, but I don't think I would want to charge patients unreasonable amounts of money for my time (we got charged $1,500 from a hospital, and another $1,500 from the ER doc).

Also, is it possible for a person to be an ER doc sometimes, and a family physician at others? It would be nice to be able to mix it up...

Thanks

 

[EM_Rebuilder]

I'm thinking about going to medical school and I like the idea of working in the ER, but I have to ask: Do ER docs decide how much patients get billed? I think if I were a doctor, I'd like to be well compensated, but I don't think I would want to charge patients unreasonable amounts of money for my time (we got charged $1,500 from a hospital, and another $1,500 from the ER doc).

Also, is it possible for a person to be an ER doc sometimes, and a family physician at others? It would be nice to be able to mix it up...

Thanks

Learn to use the Search function on here and you can learn much.

You probably got charged $1500 because your insurance had to effectively pay for 10 other patients who were self pay and will never pay their bill.

Call it unreasonable, but I want to be well compensated for spending my 20s drooling in books, going to classes, and slaving in the hospital for free.

 

[RustedFox]

+1 !

 

[deleted109597]

You can open up your own urgent care, and bill people whatever you like. You can't open up an ER and do the same, unless you didn't accept Medicare/Medicaid. It is fraud to bill someone less than Medicare would pay for the same thing.

 

[RustedFox]

Sorry, OP - nobody addressed your other question. Its not very realistically possible to do both EM and FP from time-to-time because you "wanted to". There are some family practice docs that work occasional shifts in the ER, but those locations are few and fewer between, and those days are coming to a close very soon, as the 'board-certified EP' becomes the standard.

In short, you're pretty much going to have to "pick a specialty and that's it", unless you want to become dual-boarded... which is an entirely different discussion altogether.

I think what McNinja is trying to express is that things would be much, much different if the federal government would keep its greedy little paws out of things.

 

[Bojack Horseman]

You can open up your own urgent care, and bill people whatever you like. You can't open up an ER and do the same, unless you didn't accept Medicare/Medicaid. It is fraud to bill someone less than Medicare would pay for the same thing.

can you elaborate on this?

 

[deleted109597]

can you elaborate on this?

Not sure I need to. If you accept Medicare/Medicaid, and you see a "self pay patient", you cannot adjust their payment to be any less than what Medicare/Medicaid will pay. Otherwise, you will be committing a crime. Nobody gets a better deal than the government.

 

[EctopicFetus]

Not sure I need to. If you accept Medicare/Medicaid, and you see a "self pay patient", you cannot adjust their payment to be any less than what Medicare/Medicaid will pay. Otherwise, you will be committing a crime. Nobody gets a better deal than the government.

Also, you can not legally just cut their bill. It has to go through the hospital billing dept (or your own) They have to provide financial records and then a deal gets cut.

McNinja, I have never heard of this thing where it is illegal to charge less than medicare/medicaid. One of the orthopods I work with told me they contract for less than 100% of medicare for some of their procedures.

Also in a large number of states medicaid pays less than medicare. I believe Michigan was the worst with medicaid paying less than 70% of medicare. On of the things in Obamacare was that medicaid has to pay at least 100% of medicare.

I would love to see a link or article or something regarding your post.

 

[deleted109597]

I stand corrected. I had been told multiple times that it is illegal to do so, and by so many people I had accepted it as truth. Also, since I didn't really want to delve into the OIG reports to find the answer, and honestly didn't care as I wasn't billing anyone personally, had never bothered to back it up.
However, this document by the OIG(warning: pdf) clearly states on page 5 that

For example, where the
Medicare and Medicaid programs require patients to pay copays for services, you are generally required to collect that money from your patients. Routinely waiving these copays could implicate the AKS and you may not advertise that you will forgive copayments. However, you are free to waive a copayment if you make an individual determination that the patient cannot afford to pay or if your reasonable collection efforts fail. It is also legal to provide free or discounted services to uninsured people

Emphasis theirs.
So nevermind. Provide free care for those that you see fit. Just ask for copays if they actually have Medicaid/Medicare.

 

[EctopicFetus]

I stand corrected. I had been told multiple times that it is illegal to do so, and by so many people I had accepted it as truth. Also, since I didn't really want to delve into the OIG reports to find the answer, and honestly didn't care as I wasn't billing anyone personally, had never bothered to back it up.
However, this document by the OIG(warning: pdf) clearly states on page 5 that

Emphasis theirs.
So nevermind. Provide free care for those that you see fit. Just ask for copays if they actually have Medicaid/Medicare.

My understanding is that in order to give discounted care the patient has to go through a financial interview. We can however write off cases. Our group allows us to write off our bills for patients.

 

[Rendar5]

also, look at the bill, $1500 is for a lot of services, not just for the physician bill