Mesothelioma patients and their families get very used to doctors’ offices and emergency rooms. What you never get used to are the medical bills. Even if we’re fortunate enough to have good health insurance, there are always surprises. Deductibles not met or items not covered by your insurance.
Or are they?
Could the problem just be the way the billing staff coded it? Could an incorrect code mean the difference between getting the insurance coverage you are entitled to or racking up outstanding bills? It’s possible.
In a recent nation-wide pilot study, participating medical coders produced accurate coding less than two-thirds of the time. In defense of the coders, they were road testing an upgraded coding system mandated by the federal government to be in place by October 2014. But it is something to consider when you get your next medical bill statement.
“Accuracy rates varied widely by type of medical condition coded,” states a report on the study in the professional medical news site Modern Healthcare. The research was conducted by the Healthcare Information and Management Systems Society and the Workgroup for Electronic Data Interchange.
Typically, after a doctor sees you, codes are assigned by the doctor’s billing staff for every test and procedure the doctor performed on you during the visit. These codes assist your insurance company in determining coverage and the medical necessity of the services. Once the procedure and diagnosis codes are determined, the doctor’s medical biller transmits the claim to the insurance company. This is usually done electronically; in the old days it was done by paper.
What we all dread are rejected or denied claims, usually accompanied by some kind of “explanation of benefits” form. But let this new study encourage you. Coders are not infallible. Always contact your physician’s billing office and make sure that there was no error in coding that caused an insurance claim to be rejected or denied.
One of the researchers of the current study cautioned against blaming the high rate of errors in the study solely on the coders. “It didn’t mean the coder didn’t know what they were doing,” she said. “It may have meant the medical documentation was not precise” and subject to differing interpretation. “It was a process. If we say the coder made a mistake, that’s not an accurate way to portray it.”
Maybe not, but it may mean that you’ve got a fighting chance of getting insurance coverage for that bill.