So one of my GI docs asks me to look at a case from last year sent by another doc to an outside lab, 6 part colon biopsy, UC vs diversion colitis. The outside lab did CD3 and Trichrome on all six parts, and billed for all of them. 88305x6, 88342x6 and 88313x6. This is why Anthem hates pathologists. If I raped the system like this I would be a billionaire by now. And no I am not tempted. This sh$t is not rare.
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Friggin crooks
Started by Dave CX
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Exactly why we are heading toward bundled payments.
This is not reason why we’re constantly being targeted for reimbursement cuts. Insurance companies have every right to audit their accounts to see which entities are billing well outside the standard deviation(s) of the norm and terminate those contracts. Just the same, CMS has every right to audit these practices and file false claims charges against them after a thorough investigation. We’re being targeted simply because we have never been able to mount a cohesive and meaningful response to the cuts. It’s really that simple.
Yep - have noticed this for years - the sleazy and unethical will always make their profits and then by the time the changes are made, it's hurting everyone else.
Things I have seen that have bothered me over the years:
1) Staining every single core in a 12 part prostate biopsy (one was 4+3 in every core, obvious cancer - stains were done "to confirm malignancy.")
2) Every bladder biopsy getting a Tryptase and a p53.
3) "Lung cancer panels" on lung tumor biopsies which include about 15 stains, no matter how obvious the dx.
4) "reflex" urovysion FISH on all atypical urine cytologies, with an atypical rate of close to 50%.
5) CD3/CD20 on every intestinal biopsy
6) Spinning down the formalin on every prostate core jar and making a cytospin block on it, and billing for it.
7) Flow on all the tonsils.
8) Cytogenetics and flow on every marrow, including staging Hodgkin lymphomas.
Things I have seen that have bothered me over the years:
1) Staining every single core in a 12 part prostate biopsy (one was 4+3 in every core, obvious cancer - stains were done "to confirm malignancy.")
2) Every bladder biopsy getting a Tryptase and a p53.
3) "Lung cancer panels" on lung tumor biopsies which include about 15 stains, no matter how obvious the dx.
4) "reflex" urovysion FISH on all atypical urine cytologies, with an atypical rate of close to 50%.
5) CD3/CD20 on every intestinal biopsy
6) Spinning down the formalin on every prostate core jar and making a cytospin block on it, and billing for it.
7) Flow on all the tonsils.
8) Cytogenetics and flow on every marrow, including staging Hodgkin lymphomas.
You could do something about it. There are whistleblower protections. Is this a Medicare patient?
I disagree- Medicare and private payors look at the data and see rampant abuse. Their conclusion is sometimes akin to ..."if 10% of claims are abuse, we can cut 10% and still deliver the same quality of care".
No or else I would have.
I agree. CMS and the insurance companies find this easier than doing audits.
