Medical Coding and Billing — Patient Questions About Fees

Let’s say you are the medical coding and billing manager for a large medical group practice. It’s a rewarding career because you see your staff’s efforts transforming your doctors’ hard work into serious dollars due to accurate documentation, coding, and billing.

Then one afternoon, an irate Mrs. Jones calls you up and complains about the bill she has just received. In actuality, Mrs. Jones has not even received a bill. She is holding a copy of her insurance company’s explanation of benefits and she thinks it is outrageous that the physician charges such exorbitant fees for the little time she had spent with him. You begin to realize that many patients call demanding an explanation of the fees on their statements. As a manager, how would you respond?

The first thing you want to do is be sure the patient understands exactly what her visit entailed. Spell it out for her. In fact, print up a sheet that you can hand to patients who raise an eyebrow at the prices that do not even reflect 100% reimbursement of the charged amount.

Patients won’t understand 1995-1997 E/M guidelines the way coders do so let’s take what we know, put it in letter format and spell it out in layman’s terms.

Medical Coding and Billing- Patient Questions About Fees Reponse Letter

Dear Patient:
The fees reflected for your visit today are based on the time spent with you as well as the complexity of your health issues and any treatments provided. Some of the time may include services you are unaware of. Many of the items listed below may pertain to your case:
Physicians must create and maintain a permanent medical record, review all blood test results to interpret and record in a patient’s chart. They deal with calls to and from pharmacies, call patients back or send a letter regarding lab test results, review x-ray or other diagnostic reports and discuss results with a radiologist when results are abnormal.
There are consultation reports and follow-up visit letters sent to the referring physician regarding your case, as well as phone calls to the referring or consulting physician and possibly family members if necessary.

Your physician sends out referrals requests, spends time researching information pertaining to your condition and pays for educational material handed to a patient to teach them about managing their health issue.

Our staff assists both the physician and patient by arranging other tests that are required outside the office, gathering patient information, or taking vital signs to report to the doctor.
Doctors fill out multiple forms and reports for health insurance, life insurance and disability insurance companies and work with lawyers on motor vehicle and workman’s compensation cases.
There is ample time spent reviewing and managing hospital records, dealing with hospitalization utilization review, and letters of medical necessity to obtain DME supplies a patient may require.
Physicians must send letters of medical necessity to a patient’s insurance carrier to justify a visit in order to get reimbursed.
Many patients require home health care or nursing facility care and this is information that is managed and recorded by the time spent per case.
There is always the extra paperwork a patient may require for jury duty, sick leave, or communicable diseases, etc.

Physicians must participate in continuing medical education, teaching, clinical research and writing to stay up to date on latest medical advances in his field.
Our practice is strongly committed to caring for our patients’ medical needs. But our practice’s overhead is like any other business which covers the cost of salaries, leases, taxes, insurance, postage, copying, supplies, and more.

Please note that all of the above mentioned services are calculated and paid by a system called Resource Based Relative Value Scale, which, simply stated, breaks down our reimbursement based on our work, practice expenses, malpractice expense and our geographic location.

Our fees reflect the highest standard of care and we look forward to a healthy, long lasting relationship.

Medical Group Practice

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