My wife has a lot of doctor visits and this drives me crazy. It's impossible to argue with the provider, they will never downcode a visit no matter how simple it was.
Hi Joe. Hospitals have various upcoding techniques that I used to find and defeat. Here's just one of many. They comb through lab reports and identify marginally out-of-range hemoglobin levels, e.g 13.9 gm/dL when normal range for males in their lab is , say 14-18. Then anemia gets retrospectively coded as a complicating diagnosis which raises the DRG group and payment level. And this occurs despite the fact that anemia is mentioned nowhere in the hospital progress notes or problem lists and no investigation or treatment is documented.
Thanks Dr. Jake - appreciate the insights...I'm sure this is just one of many ways providers - and Medicare Advantage Plans - have at their disposal to transfer more taxpayer and employer dollars to their coffers.
I would not be surprised if this was part of UHG's home visit playbook that got them enmeshed win the current litigation re MA premiums.
My wife has a lot of doctor visits and this drives me crazy. It's impossible to argue with the provider, they will never downcode a visit no matter how simple it was.
Thanks for the note Jeff...providers are always a few steps ahead of all payers - and a few miles ahead of workers' comp payers.
be well Joe
Hi Joe. Hospitals have various upcoding techniques that I used to find and defeat. Here's just one of many. They comb through lab reports and identify marginally out-of-range hemoglobin levels, e.g 13.9 gm/dL when normal range for males in their lab is , say 14-18. Then anemia gets retrospectively coded as a complicating diagnosis which raises the DRG group and payment level. And this occurs despite the fact that anemia is mentioned nowhere in the hospital progress notes or problem lists and no investigation or treatment is documented.
Thanks Dr. Jake - appreciate the insights...I'm sure this is just one of many ways providers - and Medicare Advantage Plans - have at their disposal to transfer more taxpayer and employer dollars to their coffers.
I would not be surprised if this was part of UHG's home visit playbook that got them enmeshed win the current litigation re MA premiums.
be well Joe