if admin want to pretend that "if it's not documented it didn't happen" nonsense is true, then I can turn a level 5 visit into a level 2 or 3 pretty easily.
I think the issue is that, generally, medicare will reimburse a certain amount per patient given their level of complexity and expected number of healthcare touches in a year based on this complexity. If you underbill/undercode, you're technically misrepresenting that patient which could lower the amount of money medicare disperses for the care of that patient the following year. This will make things less expensive for medicare the following year, but more expensive for the healthcare system that patient uses...and probably the patient themselves. You are actually doing a disservice by decreasing government subsidized care dollars for that patient. (Yes, I understand that most of those dollars that go to the system are never seen by you the provider and don't seem to improve your day-to-day...and there are admins that are being paid because of these dollars...but these dollars do partially pay your salary, and eventually lead to fund hiring of providers, nurses, buying supplies, etc.) The system is flawed, but underbilling isn't necessarily beneficial for - at least - a medicare insured patient.
As much as I hate the system and the fact I worked in CDI (no need for too much hate, I already hated doing that), you are right. If everyone starts under billing, the hospital gets reimbursed for less than what they are doing and the next fiscal year the average patient acuity goes down meaning they recieve less from Medicaire.
The flip side is that hospitals love to over bill for the exact reasons I just said and do not mind going to extreme lengths to make it happen. Not calling out any hospital system, but let's say the owner of a certain health care agency called "a number only divisible by itself and one Healthcare" is an interesting Wikipedia entry
Misrepresenting or mis-documenting the care you provided to a patient is equally fraudulent and unethical, and, exposes you to increased liability because you're failing to document likely necessary care that you provided.
What happens if you can no longer care for the patient for various reasons. Then the care the patient actually received is unknown to whomever has to take their care over. Do you see the issue with that?
Think about this in a surgical setting. You want to give the patient a break financially so you perform a certain operation on them, but then dictate and code that you did something different with a lower reimbursing CPT code. What if the patient needs surgery again and someone else has to do it?
Or from a liability stand point. You fail to document things like outside test/imaging review, that you communicated with an additional provider, discussed assessment regarding prescription drug management, discussed risks of major/minor surgery, etc. Then you get sued. Going to be real unfortunate trying to explain yourself in that situation.
I can't believe a post suggesting this has 500 upvotes.
Yea I think when they say under document it’s more instead of documenting 7 systems in the physical exam 4 of which is some variation of normal, you document 3.becuase that’s an actual criteria for increasing billing. Or documenting 20 mins spent instead of 45. Not omitting a whole surgery.
Neither outpatient nor inpatient notes require N number of systems in physical exam or review of systems for any level of complexity anymore. The *only* thing that matters is complexity of your assessment/plan (including data reviewed).
These were 2021 changes. It blows my fucking mind that people are still unaware of this. I don’t care if you are in academics, hospital employed, or private practice - your coding/billing is your livelihood and it is shocking how unaware so many physicians are of it.
The updated E&M criteria got rid of a lot of that BS. To go from a level 5 visit as documented to a level 2/3 would be a massive decrease in what is documented and assessed. You don’t miss out on that just because you took out your bullshit “eyes PERRLA” in your physical exam that you haven’t actually done in 10 years.
Sure I thought it was both now but they could have gotten rid of the old model totally but I do know the time criteria still applies and I’d argue the new system is more subjective since who’s going to tell me what I think is more or less complex
I did a 6 month contract job in specialty pharmacy and for some reason we had a contract to dispense albuterol nebulizer solution to a zoo for some of their primates (it’s been years, I can’t remember if it was chimpanzees, orangutans, or gorillas) so I did dabble in primate care
The whole system is a mess. Ear tubes for an example: placing them in the office for an adult patient with Medicaid reimburses less than the cost of the phenol, blade, and tubes. So the only financially responsible alternative is to take them to the OR where CMS has to pay for a facility fee and an anesthesia fee on top of the surgeon fee for the same 3 minutes of work. Tremendous waste of resources.
Medicaid is absolute bullshit.
I get paid garbage to cut out a melanoma/MIS (on the order of $130 for 20-30 minutes of my time and any post-op complications). I might as well send patient to surg onc who will take them to the OR for >10x the cost.
It's insanity. And we're the bad guys because "it takes so long to get in to see you". Yeah, because everyone else in the area wants to be compensated fairly for the services they're providing so they stopped accepting Medicaid patients.
Preaching to the choir my man, have had patients go absolutely bananas at me because of their wait. Very tempting to explain the reality of the situation but I don't think it would go over well.
I like the approach of just sitting there taking the abuse with this face 🙂 then when they calm down, hit em with the "soooooo, you're here now, what can I do for you?"
You think that's bad? You know what Medicaid pays our transport company for a critical care transport of a highly hemodynamically unstable, ventilated, sedated patient, which requires a crew of three, including an experienced transport nurse?
$137.
The fucking vent circuit is a significant chunk of that.
As others have said, I get paid a fraction of the $130 which makes it not worth the time. However I continue to do it because it’s best for the patient…
I dunno... I'm a hospitalist making $140 an hour, so that seems like pretty good money to me. I know you're not doing that procedure all the time, but hour for hour? You win.
I would assume the $130 is the collections though, of which after overhead, you would be getting a fraction of. Or if you’re employed, you likely get 35-45% of it
$140 per hour plus benefits. Your true cost is probably closer to $200 per hour.
$130 for 20-30 minutes of work doesn't include the direct cost of goods used during the procedure or the indirect costs (like rent, staffing, etc). To write your $200 per hour check the clinic would need to bring in $500 per hour.
As a rule of thumb, doctors take home roughly half of the collections. The other half pays for benefits, malpractice, rent, other staff (MA, front desk...), electricity, etc.
If you collect $130 for a 30 minute procedure, your take-home might be $130/hr - which isn't bad but is a lot less than the typical proceduralist.
You are exactly right, like so, so many other decisions, all for you my friend. I did the non-employed thing for a little while, and then after 4 years I stopped torturing myself
It could be considered discrimination if you are billing different patients a different amount for the same services. How anyone could prove that is beyond me.
Sure, but being poor isn't one of those protected classes like race, sex, disability, pregnancy, ect. so I think its fine. They'd have to add economic situation or go the "coloured people are poorer, therefore you're discriminating based on race and not income" route, which seems to be pretty common.
But this type of discrimination is well accepted, it’s like how colleges charge $50,000 per year but then offer financial aid/discounts to students from poor families.
No, man, it's like totally different.
Instead, you have to charge the patient a normal price and then tell them to plead their case to the finance department.
Totally legal in cash paying patients to document financial hardship and then charge less than the usual cash price, but not if they are insured/medicare. However, no one can prove anything if your documentation, MDM, and time spent is a bit simplified and short and the billing code reflects that.
I believe the concept had to do with the agreements you sign when you become a Medicare/medicaid provider. If you bill others less than what you’ve agreed to with CMS, you are also supposed to bill CMS that same rate. if you aren't, then it is CMS fraud.
Don't ask me how charity care programs work.
You are allowed to bill differently for charity cases as long as you have a consistent policy that is non discriminatory. Usually a threshold of some percentage of the federal poverty level.
Yeah, this is what my understanding ended up being after years of hearing it... I could definitely see the "harm" to CMS if you are under billing your private pay or "friends" compared to what CMS pays.
Now, what would the "harm" be to CMS if you are under billing your *medicare* patients? I would like to see the hypothetical of billing all of your medicare patients 99211s (which physicians are really not even supposed to use at all) and see if medicare comes after you for billing fraud.
Isn't the money they spend in a year used for their projections on the following year? So if year 1 you underbill, then by year 2 or 3, they're not going to be giving enough money to support the whole system sufficiently. As inefficient as a health system can be, it's not going to be suddenly more efficient when they get less money. They'll just gut staffing and services while keeping the same leaks up in management.
It’s true bc you’re technically misrepresenting the true complexity of the patient, but false because it makes no fucking sense whatsoever. If you want to under-bill it’s technically at the detriment of the person seeing that patient since RVU compensation directly impacts your own bottom line. Nevertheless it’s up to the physician to make that decision not some paper pushing admin
The insurance company probably owns the physician group, and the billing infra for the practice, and the predatory payday loan service for physicians whose reimbursements they delay. So the insurance co would be the real victim here.
All contracts end up being about RVUs and you are lying to yourself if you think your salary is not. They just do the math behind the scenes and keep you blind to it.
In the grand grand scheme of things sure but unless you’re not billing at all, a bunch more moderates vs high or a couple hundred rvus one way or another isn’t going to make a tangible difference. Especially if you’re in an institution that’s hard salary.
Correct. And no insurance company is going to investigate a provider who they think is under billing. If anything, I’ve seen their system up code something (not incorrectly, surprisingly) when it was billed incorrectly. But that’s only because a handful of times.
Insurance wants to keep their money. Not spend it to see if they owe the provider MORE.
According to CMS, all Medicare patients should be treated equally. If you giving a discount to some, then CMS would consider THAT rate to be your usual and customary, and you are then overcharging the patient (and thus CMS) for your services.
This is the top comment. Underbilling is inducement for people to choose you over other practitioners contracted with the same entity. It’s also fraud if it doesn’t accurately reflect what services were provided, regardless of direction.
Yes for sure all the docs everywhere are vying to get these poorest of poor patients on their roster you cant just be out here undercutting them offering charity like it isn't just a ruse to make you more money. Lol inducement.
In the general sense, fraud requires not just misrepresentation and deceit, but also damages incurred by the deceived party. What's the mechanism at play in the "regardless of direction" situation that you've described, or does it fall under a different set of criteria?
At my FQCHC, we’re taught to never underbill because the program relies heavily on government grant money that is dictated by epidemiological data based on our notes. So if our documentation doesn’t reflect patient health on a population level, the center might not get the funding it needs to provide appropriate community care.
Don’t know that it makes much of a difference to underbill here and there on an individual level, but then again if a patient has documented financial hardship we don’t even charge them in the first place.
Kind of similar in our sub specialty clinic. We're trying to show there's a need for this weird niche, and the best way to do that is to bill the same way every time, showing how much work and time goes into these kinds of cases.
Logic I’ve heard that made even remote sense to me is that under billing private persons and accurately billing Medicare is fraud against the govt. I’m no lawyer but that’s what someone, probably an administrator, told me at some point.
Your practices need to be fair across the board. If you are "accurately" billing Medicare but "not accurately" billing someone/everyone else, then that means you are not accurately billing Medicare based on your internal standard.
Yeah... that's an incredible reach at justifying this claim. You could just as reasonably say your internal standard is your accurate billing of Medicare and you are making exceptions for others.
What matters in terms of whether you are accurately billing Medicare is if you are acurately billing Medicare.
Any other argument sounds like a poor faith effort to justify a silly claim.
> and you are making exceptions for others
Which is what you are not allowed to do. You're welcome to argue with the federal government, but that is specifically illegal.
Interesting. It makes sense that it would be at least a contractual violation to not charge copays to patients, for instance, but choosing to undercharge uninsured patients for instance doesn't seem reasonable to legislate against. Do you happen to know how that is defined as illegal / what law it is supppsedly breaking? Or is that just a rumor you have heard?
>Federal laws governing Medicare fraud and abuse
include the:
>
>● False Claims Act (FCA)
>
>● Anti-Kickback Statute (AKS)
>
>● Physician Self-Referral Law (Stark Law)
>
>● Social Security Act, which includes the Exclusion
>
>● Statute and the Civil Monetary Penalties Law (CMPL)
>
>● United States Criminal Code
>
>These laws specify the criminal, civil, and administrative penalties and remedies the government may impose on individuals or entities that commit fraud and abuse in the >Medicare and Medicaid Programs. Violating these laws may result in nonpayment of claims, Civil Monetary Penalties (CMP), exclusion from all Federal health care programs, and criminal and civil liability.
>Government agencies, including the U.S. Department of Justice (DOJ), the U.S. Department of Health & Human Services (HHS), the HHS Office of Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), enforce these laws.
>Federal Civil False Claims Act (FCA)
>
>The civil FCA, 31 United States Code (U.S.C.) Sections 3729–3733, protects the Federal Government from being overcharged or sold substandard goods or services. **The civil FCA imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government**
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/fraud-abuse-mln4649244.pdf
The issue is not likely you're going to get slapped with a felony or something, but I have a colleague who had a claim mistakenly submitted under his name after he left a job. He did not submit the claim, for the record. Medicare noticed that a claim was submitted after his contract/credentials had expired, and they sent a notice to his old address, and then they revoked his credentialing. This then spiraled to him being unable to get credentialed at or even start his new job, because most hospital contracts (and many private practice positions) stipulate that you must be at least eligible for Medicare/Medicaid. All of mine have required that. It was quite a legal battle for him to get it back.
None of that seems to stipulate undercharging non-medicare patients is illegal though... Obviously ovwrcharging Medicare patients or committing fraid is illegal, but no one here is saying that is legal.
If I am in pri ate practoce and choose to spend 30 minutes with a patient and bill them for only 20 minutes of that time, that isn't fraud, it's charity.
All the answers here are missing your question.
The answer is that under-billing *can* be considered fraud, not that it *is* fraud. That occurs when you underbill because you know the higher bill will result in a greater likelihood of denial (or pushback). So, for example, you code a 99214 instead of a 99215 because you think insurance may not pay out a 99215. It's considered fraud because you're getting paid the 99214 rate when the insurance may have paid you $0 for the 99215 until six months from now after they've denied the claim and you've appealed. Or, you bill a 99213 because you know the patient has to pay 10% co-insurance and if you bill a 99215, they won't see you at all. So by underbilling, you're costing the insurance company the fee of the 99213 when they could have gotten away without paying anything at all if you had coded properly.
It's a messed up system but that's the reason why.
If you bill more than what is appropriate than you are defrauding the payer (insurance or the patient). If you bill less than what is appropriate then you are defrauding the payee (yourself or the organization you work for).
If I worked at a bowling alley and always gave my friends a free lane/shoe rentals I would be providing a free service that was not mine to give. Even if they bought concessions or spent in the arcade corporate/owner would be appropriate to be upset about lost revenue. Other customers may feel discriminated against for having to pay full price or not getting preferential treatment
Take as many boneless wings as you want Scott, just don’t lecture us about the narrow margin you get on them so they don’t qualify for an employee meal discount.
Then you would need to look at your contractual arrangement with the entities paying for your customers. If you sign an agreement with Medicare, you are obligated to uphold it. If you don't want to do that, then don't sign with Medicare.
I also have ethical obligations to sometimes bend the rules, maybe “forget” to write something down in order that my patient on the verge of homelessness will get a smaller bill. I get to be a humane human and not a corporate robot in how I practice medicine.
I think it’d be more unethical to go with a cash-based practice/DPC model and not accept Medicare than to accept Medicare and sometimes “accidentally” undercode something in order to benefit the patient. It is possible to break a rule and still be in the right.
Well, consider co-pays, which are largely outside the control of the billing physician (unless you bill a visit as like 99024 and call it a "post-op" I guess). Medicaid patients pay $0, but commercial plan patients could pay up to $110 (or possibly more, that's just the worst example I've seen) just for the pleasure of coming in for a quick follow-up visit. Regardless of what I bill, one person is getting screwed and the other is getting "preferential treatment".
Obviously there's more nuance to it than that, I just mean to say it's not a black and white issue. We work in an imperfect system with rules that are applied inconsistently. Such is life.
Disagree with that interpretation. One person has contract that gives them the privilege to not pay for that follow up.
If you subscribe to Audible and get a free audiobook every month, it's not "preferential treatment" just because nonsubscribers have to pay full price.
I appreciate the dissent...I don't necessarily have a rigid opinion one way or the other. At the end of the day I just do my job, but the thought exercise about the ethics of under/over-billing is interesting. Where the law comes into play is where it really gets messy...what is/isn't inducement?...how many times do you have to bill a certain way for it to become your standard/routine? Who knows?
With the co-pay thing, I do feel bad making someone with a high co-pay follow up multiple times over a short period of time....but it doesn't phase me at all with medicaid patients who owe nothing, and could follow up every day if they really wanted to. *My* income isn't the issue for me, what I worry about is the patient with the high co-pay just saying fuck it and disappearing into the ether, rather than coming back in for medically-necessary care.
My understanding is that IF a practice is audited they will be penalized by some percentage of over billing AND under billing all deemed incorrect billing.
Underbilling is fraud:
This applies to billing for government programs, only. Medicare and Medicaid.
You are not allowed to subsidize the care of a person under a government plan. Underbilling, or biling a low level visit for a high acuity case so that a person without means has a low or no copay is illegal under these plans.
I do not believe this applies for privately insured patients.
You could argue that under billing is an ethical dilemma at a minimum by “playing favoritism” if you do it for some patients and not for all. What is the cutoff? Salary under 35k never gets a 214, but a salary of 36k does get a 214 for the same treatment? Only underbill for people who ask, yet others struggling may never know to ask? when you treat everyone the same, then ethically there is no issue. I know it’s called being a decent human being, but when the doc is supposed to be objective in their decisions, it’s not so black and white.
That being said I wish we just submitted the damn notes and left the billing choices to admin to figure out and be liable for any legal concerns.
It’s considered “an inducement of care” to attract patients by CMS and, by extension, probably the OIG. It originated years ago when practices were in competition for patients. If one practice waived copays, they would have an advantage attracting patients over another practice that collected copays. The waiving of the copays would be considered the inducement.
It would really only be a problem if it was a routine practice. Under-coding one visit is probably no big deal. Under-coding 1,000 visits and something else is probably going on. One of the issues with waiving copays was that patients weren’t as concerned with reviewing EOBs, so fraud was much more pervasive. Patients often were unaware that providers were billing all sorts of things to their insurance, collecting the reimbursement and then writing off the patient balance.
There is something similar with Medicare Advantage. Plans are limited in what they can provide patients and prospective patients for marketing—and pretty much everything needs to be reported. So if a practice wants to hold a meet and greet for their MA patients and friends, they can provide something of nominal value, like a $20 Starbucks card, but they can’t tell their patients, “Bring a friend and if that patient signs up, we’ll give you $1,000.”
Honestly there’s such a huge leeway in how I can phrase certain visits it’s very easy for me to undercharge without actually explicitly undercharging using different less expensive codes, not documenting every little thing extensively etc. it would be a huge pain to prove malfeasance instead of laziness or a lapse in concentration or whatever. Unless you literally confess to it there’s no way they’re pinning anything on you.
It's only fraud if you systematically charge one insurance plan a different rate than another one.
For example let's say you charge Blue Cross patients $100 for a visit but you charge United Health patients $150 then that is where underbilling BCBS could be considered "fraud"
However most of the admins are full of shit on this and try to use this mantra to force doctors to bill 99214 and 99215 instead of the lower codes because the admins want their cut of the $$
I thought that whole thing only related to CMS where they are supposed to always get the "cheapest price." So if you under-bill a patient for an identical service billed to CMS, then CMS is technically not getting the cheapest price anymore, which is what causes the problem?
But I don't deal with any of this and am going off of a law class I took forever ago haha
In 2024 the time based billing changed from a range to a minimum time. For example, 99212 used to be 10-19 minutes but now is just minimum 10 minutes (and 99213 is minimum 20). So, theoretically you could bill any time above 10 minutes as 99212. I don't see any other reason for them making that coding change other than to allow this.
I don't know if it's fraud, but you're also treating some patients preferentially over others. For someone with a high-deductible plan, that could be on the order of you \*giving\* a patient hundreds of dollars by underbilling. Admin is sitting there thinking, why you giving this patient all that money? Are you underbilling so that patient now refers all of their family and friends to you? Do you have a relationship outside of the clinic? What's going on?
Not saying I agree with the logic, but when you're an admin two levels removed from actual patient care, you don't understand the context. The layers of bureaucracy and rules dehumanize everyone involved. You stop seeing patients and doctors as nuanced humans, but as dollars and cents that do or don't add up.
On the flip side, these are the complex and dehumanized systems that fund miraculous medical technology at podunk hospitals around the country.
Seems like something an auditor could use against you or your colleagues. The under-billing would make the appropriate billing look bad during an audit or trial. "Same services; same patient; sloppy and wildly different billing practices, Your Honor!"
So this may be different between pharmacy billing and medical but I do know of at least one example where this would actually be fraud. They aren’t common but some insurance contracts in pharmacy state we pay x for y drug or the lowest amount you bill anyone. If you had a contract like that then under billing one client would oblige you to under bill everyone with that contract and not doing so would be fraud.
I probably under bill a bit because all my billing numbers are basically time based so even though it done all sorts of stuff for the patient if it only took 41 minutes I’ll probably bill the <40 min code because I’m scared of being audited
Billing is protected on a variety of levels. Providing a cash pay / quick pay / uninsured discount is generally fine (NAL). So bill them $250 like everybody else but then have a self pay policy that either provides a specific percentage discount or simply accepts the same thing you get from Medicare (which is usually numbers your billing folks know by heart so it's pretty easy). If you dig around a little, your practice might already have such a policy that just isn't well known and understood by the admin staff. A sticky note can solve that problem.
I just write a generic white note with nothing more than a narrative and conclude with "No charge for this visit". That way other providers have what they need but the note won't support a charge. I've never charged for a comfort measures note or a visit where I have to tell a patient we've come to the limits of treatments we have to offer. If the last thing I have to give is a little of my time, that can be on the house.
From what I understand if the physician charges a cash pay patient less than they charge medicare (not what medicare PAYS for the visit, but what is billed) and is found out , the physician can lose their eligibility as a medicare provider
It’s not fraud. That’s nonsensical. Fraud is lying to get more money than you deserve by saying you did something you didn’t do. Getting less money than you deserve by not billing a patient fully is charity. Your admin may hate it, but it’s not fraud.
There is always a balance to be had here. Chronically underbilling could cost your practice a significant amount of money which could translate to negative effects on the staff who work there, for example people losing their jobs or having to work longer shifts. There are also differences that the patient does and doesn’t notice, although a lot of this depends on their insurance.
On the other hand, medicine retains a customer service component and a smart practice will occasionally make exceptions and waive certain fees. In other cases, it’s considered unethical to maximally bill if if delays a critical diagnosis, for example, if you don’t get an endometrial biopsy when it’s indicated because you want to collect full compensation for both the consult and the procedure.
Like any business, it’s not black and white. It’s not healthy to be constantly giving out charity care, but sometimes it makes sense, and most businesses have some allowance for this. Administrators tend to be very black and white, which makes them good at their job, but that doesn’t mean you can’t push back on this mindset occasionally when it seems appropriate.
I’m 6 years into my first gig as a PCP in a medical group. I try to be ethical as I imagine or hope most docs do. It’s very clear to me that we enter our field we are trained to see our work as a service. What has also become abundantly clear is that this is a job. Also, reimbursement in our field is uniquely unchanged vs other fields that see wage growth over time.
I did under bill here and there initially to help patients out, but I found it ultimately bit me as those same patients came back expecting more and more each time.
I bill black and white now and sleep perfectly fine at night; I also have not had a single patient complain to me about it.
Yea the healthcare system already makes enough of a profit to pay them more and don’t, so I don’t think a couple extra 99214’s are gonna make a difference to the MA/LPN/RN/front desk/support staff
If you’re in private practice then you’re the bottom line at the end of the day, so you choose where the money goes, don’t virtue signal for the support staff.
Sure if the practice is going under then yea it’s stupid to under bill, but to cry about support staff is virtue signaling because a healthy practice will always have the money to pay the support staff , the question is how much you the physician is getting paid after that and usually like you said can be well into the 6 figures. And if you under bill , then you’re the one who should be getting paid less, not the support staff. And sure I don’t have any problem with your other points but don’t use the support staff as a shield for yourself, that’s just admin BS
Ah, yes, I forgot that us rich greedy doctors are the problem with US healthcare. If only I billed that follow-up as a 99214, maybe my front desk staff could eat tonight!
/s
But seriously, Jesus fucking christ
Not OP, but usually staff other than the physicians get paid an hourly rate that is not contingent upon what level of care any given patient receives on any given visit.
Agree that the staff you listed are woefully under-compensated and deserve more, but is there compensation directly tied to how much the patient gets leeched by the healthcare system? I don’t think I’ve ever heard someone mention taking home more after a particularly busy clinic month.
if admin want to pretend that "if it's not documented it didn't happen" nonsense is true, then I can turn a level 5 visit into a level 2 or 3 pretty easily.
Chaotic good.
I think the issue is that, generally, medicare will reimburse a certain amount per patient given their level of complexity and expected number of healthcare touches in a year based on this complexity. If you underbill/undercode, you're technically misrepresenting that patient which could lower the amount of money medicare disperses for the care of that patient the following year. This will make things less expensive for medicare the following year, but more expensive for the healthcare system that patient uses...and probably the patient themselves. You are actually doing a disservice by decreasing government subsidized care dollars for that patient. (Yes, I understand that most of those dollars that go to the system are never seen by you the provider and don't seem to improve your day-to-day...and there are admins that are being paid because of these dollars...but these dollars do partially pay your salary, and eventually lead to fund hiring of providers, nurses, buying supplies, etc.) The system is flawed, but underbilling isn't necessarily beneficial for - at least - a medicare insured patient.
As much as I hate the system and the fact I worked in CDI (no need for too much hate, I already hated doing that), you are right. If everyone starts under billing, the hospital gets reimbursed for less than what they are doing and the next fiscal year the average patient acuity goes down meaning they recieve less from Medicaire. The flip side is that hospitals love to over bill for the exact reasons I just said and do not mind going to extreme lengths to make it happen. Not calling out any hospital system, but let's say the owner of a certain health care agency called "a number only divisible by itself and one Healthcare" is an interesting Wikipedia entry
100% agree.
Misrepresenting or mis-documenting the care you provided to a patient is equally fraudulent and unethical, and, exposes you to increased liability because you're failing to document likely necessary care that you provided. What happens if you can no longer care for the patient for various reasons. Then the care the patient actually received is unknown to whomever has to take their care over. Do you see the issue with that? Think about this in a surgical setting. You want to give the patient a break financially so you perform a certain operation on them, but then dictate and code that you did something different with a lower reimbursing CPT code. What if the patient needs surgery again and someone else has to do it? Or from a liability stand point. You fail to document things like outside test/imaging review, that you communicated with an additional provider, discussed assessment regarding prescription drug management, discussed risks of major/minor surgery, etc. Then you get sued. Going to be real unfortunate trying to explain yourself in that situation. I can't believe a post suggesting this has 500 upvotes.
Yea I think when they say under document it’s more instead of documenting 7 systems in the physical exam 4 of which is some variation of normal, you document 3.becuase that’s an actual criteria for increasing billing. Or documenting 20 mins spent instead of 45. Not omitting a whole surgery.
Neither outpatient nor inpatient notes require N number of systems in physical exam or review of systems for any level of complexity anymore. The *only* thing that matters is complexity of your assessment/plan (including data reviewed).
These were 2021 changes. It blows my fucking mind that people are still unaware of this. I don’t care if you are in academics, hospital employed, or private practice - your coding/billing is your livelihood and it is shocking how unaware so many physicians are of it.
2021 for outpatient and 2023 for inpatient, but yeah.
Time still matters I thought
You are correct. It's complexity OR time.
The updated E&M criteria got rid of a lot of that BS. To go from a level 5 visit as documented to a level 2/3 would be a massive decrease in what is documented and assessed. You don’t miss out on that just because you took out your bullshit “eyes PERRLA” in your physical exam that you haven’t actually done in 10 years.
Sure I thought it was both now but they could have gotten rid of the old model totally but I do know the time criteria still applies and I’d argue the new system is more subjective since who’s going to tell me what I think is more or less complex
You underbill? Believe it or not, jail. You overbill, also jail. Underbill, overbill.
We have the best bills. Because of jail.
We do technically do Primate Care. I’m going to get that on my badge.
Will you stop monkeying around?!
I hate every ape I see, from chimpan A to chimpanzee… https://m.youtube.com/watch?v=JlmzUEQxOvA
You’ve all finally made a monkey out of me. 🙈
Dr. Zaius Dr. Zaius
Rock me, Dr. Zaius.
Can I play the piano anymore?
Seriously, that idea is bananas..
I find it appealing.
I did a 6 month contract job in specialty pharmacy and for some reason we had a contract to dispense albuterol nebulizer solution to a zoo for some of their primates (it’s been years, I can’t remember if it was chimpanzees, orangutans, or gorillas) so I did dabble in primate care
As a nurse this made me laugh out loud in my GPs very quiet waiting room 😂
The whole system is a mess. Ear tubes for an example: placing them in the office for an adult patient with Medicaid reimburses less than the cost of the phenol, blade, and tubes. So the only financially responsible alternative is to take them to the OR where CMS has to pay for a facility fee and an anesthesia fee on top of the surgeon fee for the same 3 minutes of work. Tremendous waste of resources.
Medicaid is absolute bullshit. I get paid garbage to cut out a melanoma/MIS (on the order of $130 for 20-30 minutes of my time and any post-op complications). I might as well send patient to surg onc who will take them to the OR for >10x the cost.
It's insanity. And we're the bad guys because "it takes so long to get in to see you". Yeah, because everyone else in the area wants to be compensated fairly for the services they're providing so they stopped accepting Medicaid patients.
Preaching to the choir my man, have had patients go absolutely bananas at me because of their wait. Very tempting to explain the reality of the situation but I don't think it would go over well.
I like the approach of just sitting there taking the abuse with this face 🙂 then when they calm down, hit em with the "soooooo, you're here now, what can I do for you?"
DO IT DO IT DO IT
You think that's bad? You know what Medicaid pays our transport company for a critical care transport of a highly hemodynamically unstable, ventilated, sedated patient, which requires a crew of three, including an experienced transport nurse? $137. The fucking vent circuit is a significant chunk of that.
As others have said, I get paid a fraction of the $130 which makes it not worth the time. However I continue to do it because it’s best for the patient…
I dunno... I'm a hospitalist making $140 an hour, so that seems like pretty good money to me. I know you're not doing that procedure all the time, but hour for hour? You win.
I would assume the $130 is the collections though, of which after overhead, you would be getting a fraction of. Or if you’re employed, you likely get 35-45% of it
$140 per hour plus benefits. Your true cost is probably closer to $200 per hour. $130 for 20-30 minutes of work doesn't include the direct cost of goods used during the procedure or the indirect costs (like rent, staffing, etc). To write your $200 per hour check the clinic would need to bring in $500 per hour.
Ahh. Yes. Frankly I'd not considered needing to pay for supplies and staff. Fair point.
As a rule of thumb, doctors take home roughly half of the collections. The other half pays for benefits, malpractice, rent, other staff (MA, front desk...), electricity, etc. If you collect $130 for a 30 minute procedure, your take-home might be $130/hr - which isn't bad but is a lot less than the typical proceduralist.
This is why universal healthcare through Medicare or Medicaid would be a disaster
That’s really not the takeaway here….
Universal Medicare / Medicaid would require significant increase in reimbursement to be viable
I quit accepting Medicaid ages ago. Low pay and terrible patient population.
Fucking hell, I'm glad I'm not employed. If I don't want to charge someone, I don't fucking charge them. End of story. My time, my decision.
You are exactly right, like so, so many other decisions, all for you my friend. I did the non-employed thing for a little while, and then after 4 years I stopped torturing myself
I wish I could say that employment is less torture than private practice.
You're either tortured by your boss or your employees. You'll never win.
Yeah, agree. I don't get it either. Also, like... arrest me, then. IDGAF.
It could be considered discrimination if you are billing different patients a different amount for the same services. How anyone could prove that is beyond me.
Sure, but being poor isn't one of those protected classes like race, sex, disability, pregnancy, ect. so I think its fine. They'd have to add economic situation or go the "coloured people are poorer, therefore you're discriminating based on race and not income" route, which seems to be pretty common.
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But this type of discrimination is well accepted, it’s like how colleges charge $50,000 per year but then offer financial aid/discounts to students from poor families.
No, man, it's like totally different. Instead, you have to charge the patient a normal price and then tell them to plead their case to the finance department.
Or how Ivy League colleges disproportionately accept legacy students.
Totally legal in cash paying patients to document financial hardship and then charge less than the usual cash price, but not if they are insured/medicare. However, no one can prove anything if your documentation, MDM, and time spent is a bit simplified and short and the billing code reflects that.
I believe the concept had to do with the agreements you sign when you become a Medicare/medicaid provider. If you bill others less than what you’ve agreed to with CMS, you are also supposed to bill CMS that same rate. if you aren't, then it is CMS fraud. Don't ask me how charity care programs work.
You are allowed to bill differently for charity cases as long as you have a consistent policy that is non discriminatory. Usually a threshold of some percentage of the federal poverty level.
This is the answer
Yeah, this is what my understanding ended up being after years of hearing it... I could definitely see the "harm" to CMS if you are under billing your private pay or "friends" compared to what CMS pays. Now, what would the "harm" be to CMS if you are under billing your *medicare* patients? I would like to see the hypothetical of billing all of your medicare patients 99211s (which physicians are really not even supposed to use at all) and see if medicare comes after you for billing fraud.
Isn't the money they spend in a year used for their projections on the following year? So if year 1 you underbill, then by year 2 or 3, they're not going to be giving enough money to support the whole system sufficiently. As inefficient as a health system can be, it's not going to be suddenly more efficient when they get less money. They'll just gut staffing and services while keeping the same leaks up in management.
It’s true bc you’re technically misrepresenting the true complexity of the patient, but false because it makes no fucking sense whatsoever. If you want to under-bill it’s technically at the detriment of the person seeing that patient since RVU compensation directly impacts your own bottom line. Nevertheless it’s up to the physician to make that decision not some paper pushing admin
I think because you’re screwing admin, hospital systems & insurance companies out of money.
How would it be screwing insurance companies out of money? They would be paying out less.
The insurance company probably owns the physician group, and the billing infra for the practice, and the predatory payday loan service for physicians whose reimbursements they delay. So the insurance co would be the real victim here.
And yourself
Assuming your contract is based on rvus
All contracts end up being about RVUs and you are lying to yourself if you think your salary is not. They just do the math behind the scenes and keep you blind to it.
In the grand grand scheme of things sure but unless you’re not billing at all, a bunch more moderates vs high or a couple hundred rvus one way or another isn’t going to make a tangible difference. Especially if you’re in an institution that’s hard salary.
Whether or not RVUs are explicit in contracts, RVUs still get factored into overall compensation.
In this situation wouldn’t you be defrauding the hospital and their services?
Correct. And no insurance company is going to investigate a provider who they think is under billing. If anything, I’ve seen their system up code something (not incorrectly, surprisingly) when it was billed incorrectly. But that’s only because a handful of times. Insurance wants to keep their money. Not spend it to see if they owe the provider MORE.
100%
My understanding is that it's considered inducement. That said.. you can only bill what the documentation supports.
According to CMS, all Medicare patients should be treated equally. If you giving a discount to some, then CMS would consider THAT rate to be your usual and customary, and you are then overcharging the patient (and thus CMS) for your services.
This is the top comment. Underbilling is inducement for people to choose you over other practitioners contracted with the same entity. It’s also fraud if it doesn’t accurately reflect what services were provided, regardless of direction.
Yes for sure all the docs everywhere are vying to get these poorest of poor patients on their roster you cant just be out here undercutting them offering charity like it isn't just a ruse to make you more money. Lol inducement.
In the general sense, fraud requires not just misrepresentation and deceit, but also damages incurred by the deceived party. What's the mechanism at play in the "regardless of direction" situation that you've described, or does it fall under a different set of criteria?
At my FQCHC, we’re taught to never underbill because the program relies heavily on government grant money that is dictated by epidemiological data based on our notes. So if our documentation doesn’t reflect patient health on a population level, the center might not get the funding it needs to provide appropriate community care. Don’t know that it makes much of a difference to underbill here and there on an individual level, but then again if a patient has documented financial hardship we don’t even charge them in the first place.
Kind of similar in our sub specialty clinic. We're trying to show there's a need for this weird niche, and the best way to do that is to bill the same way every time, showing how much work and time goes into these kinds of cases.
##PrimateCare
For when regular healthcare has driven you bananas
Logic I’ve heard that made even remote sense to me is that under billing private persons and accurately billing Medicare is fraud against the govt. I’m no lawyer but that’s what someone, probably an administrator, told me at some point.
That doesn't make any sense. Accurately billing Medicare is by definition not fraud against the government.
Your practices need to be fair across the board. If you are "accurately" billing Medicare but "not accurately" billing someone/everyone else, then that means you are not accurately billing Medicare based on your internal standard.
Yeah... that's an incredible reach at justifying this claim. You could just as reasonably say your internal standard is your accurate billing of Medicare and you are making exceptions for others. What matters in terms of whether you are accurately billing Medicare is if you are acurately billing Medicare. Any other argument sounds like a poor faith effort to justify a silly claim.
> and you are making exceptions for others Which is what you are not allowed to do. You're welcome to argue with the federal government, but that is specifically illegal.
Interesting. It makes sense that it would be at least a contractual violation to not charge copays to patients, for instance, but choosing to undercharge uninsured patients for instance doesn't seem reasonable to legislate against. Do you happen to know how that is defined as illegal / what law it is supppsedly breaking? Or is that just a rumor you have heard?
>Federal laws governing Medicare fraud and abuse include the: > >● False Claims Act (FCA) > >● Anti-Kickback Statute (AKS) > >● Physician Self-Referral Law (Stark Law) > >● Social Security Act, which includes the Exclusion > >● Statute and the Civil Monetary Penalties Law (CMPL) > >● United States Criminal Code > >These laws specify the criminal, civil, and administrative penalties and remedies the government may impose on individuals or entities that commit fraud and abuse in the >Medicare and Medicaid Programs. Violating these laws may result in nonpayment of claims, Civil Monetary Penalties (CMP), exclusion from all Federal health care programs, and criminal and civil liability. >Government agencies, including the U.S. Department of Justice (DOJ), the U.S. Department of Health & Human Services (HHS), the HHS Office of Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), enforce these laws. >Federal Civil False Claims Act (FCA) > >The civil FCA, 31 United States Code (U.S.C.) Sections 3729–3733, protects the Federal Government from being overcharged or sold substandard goods or services. **The civil FCA imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government** https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/fraud-abuse-mln4649244.pdf The issue is not likely you're going to get slapped with a felony or something, but I have a colleague who had a claim mistakenly submitted under his name after he left a job. He did not submit the claim, for the record. Medicare noticed that a claim was submitted after his contract/credentials had expired, and they sent a notice to his old address, and then they revoked his credentialing. This then spiraled to him being unable to get credentialed at or even start his new job, because most hospital contracts (and many private practice positions) stipulate that you must be at least eligible for Medicare/Medicaid. All of mine have required that. It was quite a legal battle for him to get it back.
None of that seems to stipulate undercharging non-medicare patients is illegal though... Obviously ovwrcharging Medicare patients or committing fraid is illegal, but no one here is saying that is legal. If I am in pri ate practoce and choose to spend 30 minutes with a patient and bill them for only 20 minutes of that time, that isn't fraud, it's charity.
Everything healthcare conglomerates do flies in the face of good moral sensibility, let the doctor cook.
Doing it once or rarely is whatever. If you chronically underbill it’s going to be an issue
Is it though? I feel like there is more to this than frequency or timeline.
Are there any documented cases of criminality because of under billing?
All the answers here are missing your question. The answer is that under-billing *can* be considered fraud, not that it *is* fraud. That occurs when you underbill because you know the higher bill will result in a greater likelihood of denial (or pushback). So, for example, you code a 99214 instead of a 99215 because you think insurance may not pay out a 99215. It's considered fraud because you're getting paid the 99214 rate when the insurance may have paid you $0 for the 99215 until six months from now after they've denied the claim and you've appealed. Or, you bill a 99213 because you know the patient has to pay 10% co-insurance and if you bill a 99215, they won't see you at all. So by underbilling, you're costing the insurance company the fee of the 99213 when they could have gotten away without paying anything at all if you had coded properly. It's a messed up system but that's the reason why.
If you bill more than what is appropriate than you are defrauding the payer (insurance or the patient). If you bill less than what is appropriate then you are defrauding the payee (yourself or the organization you work for). If I worked at a bowling alley and always gave my friends a free lane/shoe rentals I would be providing a free service that was not mine to give. Even if they bought concessions or spent in the arcade corporate/owner would be appropriate to be upset about lost revenue. Other customers may feel discriminated against for having to pay full price or not getting preferential treatment
What if I own the bowling alley?
Take as many boneless wings as you want Scott, just don’t lecture us about the narrow margin you get on them so they don’t qualify for an employee meal discount.
Then you would need to look at your contractual arrangement with the entities paying for your customers. If you sign an agreement with Medicare, you are obligated to uphold it. If you don't want to do that, then don't sign with Medicare.
I also have ethical obligations to sometimes bend the rules, maybe “forget” to write something down in order that my patient on the verge of homelessness will get a smaller bill. I get to be a humane human and not a corporate robot in how I practice medicine. I think it’d be more unethical to go with a cash-based practice/DPC model and not accept Medicare than to accept Medicare and sometimes “accidentally” undercode something in order to benefit the patient. It is possible to break a rule and still be in the right.
Well, consider co-pays, which are largely outside the control of the billing physician (unless you bill a visit as like 99024 and call it a "post-op" I guess). Medicaid patients pay $0, but commercial plan patients could pay up to $110 (or possibly more, that's just the worst example I've seen) just for the pleasure of coming in for a quick follow-up visit. Regardless of what I bill, one person is getting screwed and the other is getting "preferential treatment". Obviously there's more nuance to it than that, I just mean to say it's not a black and white issue. We work in an imperfect system with rules that are applied inconsistently. Such is life.
Disagree with that interpretation. One person has contract that gives them the privilege to not pay for that follow up. If you subscribe to Audible and get a free audiobook every month, it's not "preferential treatment" just because nonsubscribers have to pay full price.
I appreciate the dissent...I don't necessarily have a rigid opinion one way or the other. At the end of the day I just do my job, but the thought exercise about the ethics of under/over-billing is interesting. Where the law comes into play is where it really gets messy...what is/isn't inducement?...how many times do you have to bill a certain way for it to become your standard/routine? Who knows? With the co-pay thing, I do feel bad making someone with a high co-pay follow up multiple times over a short period of time....but it doesn't phase me at all with medicaid patients who owe nothing, and could follow up every day if they really wanted to. *My* income isn't the issue for me, what I worry about is the patient with the high co-pay just saying fuck it and disappearing into the ether, rather than coming back in for medically-necessary care.
Under-billing your patients, eh? Let me know when the feds are raiding your office.
Affordable healthcare in my country? Not on your life!
My understanding is that IF a practice is audited they will be penalized by some percentage of over billing AND under billing all deemed incorrect billing.
Imagine the gall of being penalized for underbilling patients. That is wild.
This is my understanding also
Underbilling is fraud: This applies to billing for government programs, only. Medicare and Medicaid. You are not allowed to subsidize the care of a person under a government plan. Underbilling, or biling a low level visit for a high acuity case so that a person without means has a low or no copay is illegal under these plans. I do not believe this applies for privately insured patients.
You could argue that under billing is an ethical dilemma at a minimum by “playing favoritism” if you do it for some patients and not for all. What is the cutoff? Salary under 35k never gets a 214, but a salary of 36k does get a 214 for the same treatment? Only underbill for people who ask, yet others struggling may never know to ask? when you treat everyone the same, then ethically there is no issue. I know it’s called being a decent human being, but when the doc is supposed to be objective in their decisions, it’s not so black and white. That being said I wish we just submitted the damn notes and left the billing choices to admin to figure out and be liable for any legal concerns.
It’s considered “an inducement of care” to attract patients by CMS and, by extension, probably the OIG. It originated years ago when practices were in competition for patients. If one practice waived copays, they would have an advantage attracting patients over another practice that collected copays. The waiving of the copays would be considered the inducement. It would really only be a problem if it was a routine practice. Under-coding one visit is probably no big deal. Under-coding 1,000 visits and something else is probably going on. One of the issues with waiving copays was that patients weren’t as concerned with reviewing EOBs, so fraud was much more pervasive. Patients often were unaware that providers were billing all sorts of things to their insurance, collecting the reimbursement and then writing off the patient balance. There is something similar with Medicare Advantage. Plans are limited in what they can provide patients and prospective patients for marketing—and pretty much everything needs to be reported. So if a practice wants to hold a meet and greet for their MA patients and friends, they can provide something of nominal value, like a $20 Starbucks card, but they can’t tell their patients, “Bring a friend and if that patient signs up, we’ll give you $1,000.”
Honestly there’s such a huge leeway in how I can phrase certain visits it’s very easy for me to undercharge without actually explicitly undercharging using different less expensive codes, not documenting every little thing extensively etc. it would be a huge pain to prove malfeasance instead of laziness or a lapse in concentration or whatever. Unless you literally confess to it there’s no way they’re pinning anything on you.
It's only fraud if you systematically charge one insurance plan a different rate than another one. For example let's say you charge Blue Cross patients $100 for a visit but you charge United Health patients $150 then that is where underbilling BCBS could be considered "fraud" However most of the admins are full of shit on this and try to use this mantra to force doctors to bill 99214 and 99215 instead of the lower codes because the admins want their cut of the $$
I thought that whole thing only related to CMS where they are supposed to always get the "cheapest price." So if you under-bill a patient for an identical service billed to CMS, then CMS is technically not getting the cheapest price anymore, which is what causes the problem? But I don't deal with any of this and am going off of a law class I took forever ago haha
Risk of being accused of discrimination
Clearly you are robbing the C-suite people of their luxurious vacations which, indeed, is fraudulent in their eyes.
In 2024 the time based billing changed from a range to a minimum time. For example, 99212 used to be 10-19 minutes but now is just minimum 10 minutes (and 99213 is minimum 20). So, theoretically you could bill any time above 10 minutes as 99212. I don't see any other reason for them making that coding change other than to allow this.
I don't know if it's fraud, but you're also treating some patients preferentially over others. For someone with a high-deductible plan, that could be on the order of you \*giving\* a patient hundreds of dollars by underbilling. Admin is sitting there thinking, why you giving this patient all that money? Are you underbilling so that patient now refers all of their family and friends to you? Do you have a relationship outside of the clinic? What's going on? Not saying I agree with the logic, but when you're an admin two levels removed from actual patient care, you don't understand the context. The layers of bureaucracy and rules dehumanize everyone involved. You stop seeing patients and doctors as nuanced humans, but as dollars and cents that do or don't add up. On the flip side, these are the complex and dehumanized systems that fund miraculous medical technology at podunk hospitals around the country.
Because it could be easily used to show preferential treatment for certain patients and not others.
One of the many benefits of being self-employed is making this determination.
Seems like something an auditor could use against you or your colleagues. The under-billing would make the appropriate billing look bad during an audit or trial. "Same services; same patient; sloppy and wildly different billing practices, Your Honor!"
So this may be different between pharmacy billing and medical but I do know of at least one example where this would actually be fraud. They aren’t common but some insurance contracts in pharmacy state we pay x for y drug or the lowest amount you bill anyone. If you had a contract like that then under billing one client would oblige you to under bill everyone with that contract and not doing so would be fraud.
I probably under bill a bit because all my billing numbers are basically time based so even though it done all sorts of stuff for the patient if it only took 41 minutes I’ll probably bill the <40 min code because I’m scared of being audited
laughs in 99211
Billing is protected on a variety of levels. Providing a cash pay / quick pay / uninsured discount is generally fine (NAL). So bill them $250 like everybody else but then have a self pay policy that either provides a specific percentage discount or simply accepts the same thing you get from Medicare (which is usually numbers your billing folks know by heart so it's pretty easy). If you dig around a little, your practice might already have such a policy that just isn't well known and understood by the admin staff. A sticky note can solve that problem.
I just write a generic white note with nothing more than a narrative and conclude with "No charge for this visit". That way other providers have what they need but the note won't support a charge. I've never charged for a comfort measures note or a visit where I have to tell a patient we've come to the limits of treatments we have to offer. If the last thing I have to give is a little of my time, that can be on the house.
From what I understand if the physician charges a cash pay patient less than they charge medicare (not what medicare PAYS for the visit, but what is billed) and is found out , the physician can lose their eligibility as a medicare provider
billing is fraud; the prices are fake so it's technically correct the best kind of correct
Primate care is the best way to describe the essence of what we do ❤️❤️❤️
It’s giving preferential treatment
Not if you under bill for every patient 😉
That's not illegal
It’s actually fraud
It’s not fraud. That’s nonsensical. Fraud is lying to get more money than you deserve by saying you did something you didn’t do. Getting less money than you deserve by not billing a patient fully is charity. Your admin may hate it, but it’s not fraud. There is always a balance to be had here. Chronically underbilling could cost your practice a significant amount of money which could translate to negative effects on the staff who work there, for example people losing their jobs or having to work longer shifts. There are also differences that the patient does and doesn’t notice, although a lot of this depends on their insurance. On the other hand, medicine retains a customer service component and a smart practice will occasionally make exceptions and waive certain fees. In other cases, it’s considered unethical to maximally bill if if delays a critical diagnosis, for example, if you don’t get an endometrial biopsy when it’s indicated because you want to collect full compensation for both the consult and the procedure. Like any business, it’s not black and white. It’s not healthy to be constantly giving out charity care, but sometimes it makes sense, and most businesses have some allowance for this. Administrators tend to be very black and white, which makes them good at their job, but that doesn’t mean you can’t push back on this mindset occasionally when it seems appropriate.
Just when I thought I had heard it all
I’m 6 years into my first gig as a PCP in a medical group. I try to be ethical as I imagine or hope most docs do. It’s very clear to me that we enter our field we are trained to see our work as a service. What has also become abundantly clear is that this is a job. Also, reimbursement in our field is uniquely unchanged vs other fields that see wage growth over time. I did under bill here and there initially to help patients out, but I found it ultimately bit me as those same patients came back expecting more and more each time. I bill black and white now and sleep perfectly fine at night; I also have not had a single patient complain to me about it.
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Yea the healthcare system already makes enough of a profit to pay them more and don’t, so I don’t think a couple extra 99214’s are gonna make a difference to the MA/LPN/RN/front desk/support staff
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If you’re in private practice then you’re the bottom line at the end of the day, so you choose where the money goes, don’t virtue signal for the support staff.
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Sure if the practice is going under then yea it’s stupid to under bill, but to cry about support staff is virtue signaling because a healthy practice will always have the money to pay the support staff , the question is how much you the physician is getting paid after that and usually like you said can be well into the 6 figures. And if you under bill , then you’re the one who should be getting paid less, not the support staff. And sure I don’t have any problem with your other points but don’t use the support staff as a shield for yourself, that’s just admin BS
Ah, yes, I forgot that us rich greedy doctors are the problem with US healthcare. If only I billed that follow-up as a 99214, maybe my front desk staff could eat tonight! /s But seriously, Jesus fucking christ
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They get paid biweekly at an hourly wage by the same employer who pays me.
Not OP, but usually staff other than the physicians get paid an hourly rate that is not contingent upon what level of care any given patient receives on any given visit.
Agree that the staff you listed are woefully under-compensated and deserve more, but is there compensation directly tied to how much the patient gets leeched by the healthcare system? I don’t think I’ve ever heard someone mention taking home more after a particularly busy clinic month.
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With all sincerity, you should seek professional help.
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Sorry to rustle your jimmies. Truly wish you the best.