Health Care Billing: 'A Giant Shell Game'

Boy if this is not the truth....the CPT Codes are updated, changed, added to, etc. on a regular basis...and then before you get to the CPT process, you first need the ICD-9 Diagnosis code...and the 2 better match up as well when it comes to getting your medical claim paid...and that's why there are clearinghouses to check for accuracy and scrubbed before they are sent on to the payer...which brings me around to one point here...in the new Google Health Records, the diagnosis is the verbiage for the ICD-9 codes, which is a help as the consumer now can see what the "code" is for their diagnosis...I see this as a help for the average consumer being able to at least see one side of the billing process...no wonder it's difficult for the practice to give a patient an estimate of what the final charge may be outside the normal 99213 code for an average office visit...and then again insurers complicate matters with their own set of rules regarding the compensation and can vary from one carrier to another...BD

Health wonks sometimes talk about bringing transparency to health care pricing as if it were a simple matter of pulling back the curtain to reveal hidden costs. But in many cases, pulling back the curtain reveals only a jumbled mess of complicated billing codes.
As family doc and WSJ.com columnist Ben Brewer notes today: I’m required to provide a payment code for the level of service provided, with a higher rate for new patients compared with established patients. The complexity of the visit and the level of medical decision-making get coded, too. … Then I must code every drug or vaccine I gave in the office, using a separate number for each medicine and a different code if the nurse gave the injection. … Sometimes it feels like a giant shell game in which health plans are the winners and the doctors, trying to miss the fewest five-digit numbers each day, are the losers.
Brewer says that, despite all the complexity, he could publish his rates. But why should he tip his financial hand when health plans and hospitals keep their charges under wraps. Rates should be transparent, he writes, and when “the insurers and hospitals show theirs, I’ll show mine.”

Health Blog : Health Care Billing: 'A Giant Shell Game'