Aside 16 Mar

Friday, March 14, 2014, was my last day in healthcare as a biller. Seven years in reimbursement. It’s been an interesting, frustrating experience at times. I’m not sad to be moving on, but the things I’ve learned really have opened my eyes to how flawed the American system really is when it comes to providing consistently affordable maintenance healthcare. 
So I thought I would write down a quick list of the things I’ve learned in hopes it may help you. Or the healing process (ha!). Really, I’m tired of working Medicare audits this week.
1. Insurance companies are assholes. They only care about their shareholders interests or the law. If they can prove any reason not to pay something they will. Every time.
2. If anyone says, “You’re insurance will cover it” punch them in the gut and give them my Twitter handle. Your insurance will accept the charges but everything is still subject to coinsurance, copays, and the DEDUCTIBLE. You should be hearing hushing, ominous music in your head. Learn what those are for your policy. Be discerning when suggested treatment and equipment. Discuss with everyone.
3. Most all equipment “rents” for several months THEN it “converts to a purchase”. Most of the stuff I dealt with was for aged and elderly: Hospital beds, nebulizers, wheelchairs, etc. Oxygen rents but never converts. Hey, there are no absolutes. Insurance and government payers do this to reduce costs. They have no way of knowing just exactly how long you will use whatever and they’re not medical equipment Santa.
4. This entire field and business is over-complicated, messy, and automated. Claims are flying out the door all the time, payments are coming in, errors errywhere. Ask someone how the billing works before you troll them how it’s supposed to work.
5. Due to the penalties, jail time, and sheer amount of work it would take (laziness wins) there are very few companies that are willfully billing fraudulently. It’s almost impossible to overbill a medical payer because of how claims are adjudicated and the established rate. I could bill Medicare all day $300 for a box of bandages. They’re only going to pay $2.10. Things are billed with codes, codes match dollar amounts and limits for time frames (only 500 bandages a month!), and if everything lines up there’s some payment. Medical billing is unlike any other billing. 

There’s plenty more, but really that’s the short of it. If you understand that much it’s not so scary, at least based anecdotally on the hundreds of phone calls I’ve taken.