HealthCare Savvy


The Mysteries Of Medical Billing Codes Revealed

(Alex E. Proimos/flickr)

Do yourself a favor and read this helpful post on Healthcare Savvy about decoding medical billing codes written by Susan Mathisen. Here’s a chunk:

…medical coding is a locked answer booklet, oftentimes only decipherable by health care professionals and those within the medical coding profession. That’s because the American Medical Association (AMA) keeps a tight lid on what these codes mean, mostly so that they can keep their billing practices under wraps, but also to make money. But what can you do about this as a patient? Well, as it turns out, quite a bit. Let’s find out how you can figure out what your medical coding means.

What Is The Most Common Medical Coding?

Chances are the medical coding you’re seeing on your documentation is the Current Procedural Terminology, or the CPT for short. These medical coding numbers are assigned to each and every task, service, treatment or health care plan that a doctor provides for their patient (with the exception of those covered by Medicare). This includes:

Medical diagnosis
Surgical procedures
Diagnostic services
And just about everything else a doctor provides Continue reading

How To Sell Us On Your ACO

Accountable Care Organizations are hot and getting hotter, nationally and as part of the Massachusetts health reform that just became law. (What are they? We try to explain in the 5-minute cartoon above.)

So the latest Healthcare Savvy post from WBUR’s Martha Bebinger is supremely timely: She puts the health care establishment on notice about what she, as an unusually savvy health care consumer, is looking for in an ACO. And as her less savvy but similarly health-care-minded colleague, I can only say, “Right on, Martha. Everything you want, I’d want too.” (Except for maybe the acupuncture.)

WBUR’s Martha Bebinger

Readers, to mangle Freud’s classic what-does-a-woman-want phrase: What does a patient want?? Now, as more and more ACOs are being formed, would be a great time to weigh in. Martha’s post begins:

I keep hearing that one day soon we’ll all be members of an Accountable Care Organization (ACO). These are big or biggish health care groups that include doctors, hospitals, labs, rehab and other things I need. The deal, as I understand it, is that I get everybody coordinating my care “under one roof”, but I’m not supposed to go outside that roof for care. I know, some ACOs let patients continue to have unlimited choice, but that doesn’t seem to be the model.

If I’m going to give up the option of going wherever I want, then what I get under that one roof better look pretty good. So, you ACOs out there, that are getting ready to sell me on your services, here’s what I’m looking for:

1) A primary care doc who responds pretty quickly to my calls, emails, texts or Skype (or has a fabulous nurse practitioner or physician’s assistant who gets right back to me). Someone who routinely asks how I’m feeling, not just whether my body is OK. Someone who makes eye contact and can explain what’s going on with words I understand.

2) A dentist who does the same (and who shares records with my doc.)

3) Evening and weekend office and lab hours. Continue reading

The Health Care Cost Runaround: We Can’t Tell You How Much It Is

“The dark ages of health care transparency” is the refined title of WBUR’s Martha Bebinger’s latest post on Healthcare Savvy. I think I’d translate that as, “How the heck are we supposed to try to be ‘value’-seeking health care consumers when we can’t even get simple answers on how much the darned care costs?”

That’s my take, anyway, on Martha’s dark tale of trying to figure out how much some adolescent counseling will cost — and then being told that the information she’s just patiently ferreted out is only briefly valid anyway. We all have stories like this, of endless frustrating hours on the phone with insurers and providers; it’s just that Martha is naturally attuned to the policy implications. To wit:

OK – so I just spent 30 minutes on a series of phone calls to get a price that is only good for the moment? And this is the system in which I’m supposed to be a more “engaged consumer”?

Wait, the folks in state government say, it will get better soon. How? I ask. The state is collecting all the claims made to all the insurers and plans to create a database that we consumers can browse. But here’s the catch. The data will always be old – it won’t be real-time prices. So even when/if this big new database is up and running, I wouldn’t be able to get the price for counseling that I needed last week.

Your One-Stop Shop For No-Co-Pay Care

WBUR's Martha Bebinger

More from WBUR’s Martha Bebinger (Yes, it’s a Martha morning!): On our new Healthcare Savvy site, where users can share and compare their health costs, she reminds us here that under national health reform, a lot of preventive care is now supposed to be free. That is, free of co-pays.

But like everything in health reform, it’s complicated, practices vary and there are exceptions. So she’s done the legwork of getting the lists from the three major Massachusetts health insurers of their preventive services that should now be free of co-pays. See her post here.

What Every Patient Should Know About Shopping For Health Care

When I recently decided to shop around for a pelvic ultrasound ordered by my doctor, I discovered something sobering:

We comparison-shop for cereal, so why not for health care?

Within a 7-mile radius in greater Boston, the pricetag for the very same diagnostic test varied widely, from $500 to $2,500. “Eye-opening,” was the way Robert Seifert, a principal associate at the Center for Health Law and Economics at the University of Massachusetts Medical School, described it.

My family, like most in Massachusetts, has health insurance that covers this type of test, so normally I wouldn’t have cared too much about the cost. But I was motivated to find out because a colleague, WBUR’s Martha Bebinger just launched a new social networking site, Healthcare Savvy, that allows patients to compare prices, share ideas on bringing down the cost of health care and generally vent.

So, inspired by this new community, I set out to do something radical: comparison shop for health care. Here’s what I learned:

At the prestigious downtown Boston teaching hospital, Massachusetts General, I was quoted a price of $2,563 for my ultrasound. At the well-respected community hospital, Mount Auburn in Cambridge (where both of my children were born), the price was $971.96. At Diagnostic Ultrasound Associates, the stand-alone imaging center in the Longwood section of town, I was told the price was $519. (After I posted my story on the Savvy site, I got a note from the interim CEO of another Harvard teaching hospital, Beth Isreal Deaconess Medical Center, who said at his hospital, the test would be $307. Sold.)

With national health reform unfolding, and pressure mounting for greater price transparency and lower costs, patients are being pushed, inexorably, to become smarter health-care shoppers. Right now, most of us still have “no skin in the game” as the policy types like to say, meaning, essentially, we don’t feel the pain of paying for our health care. Sure, we cough up cash for co-pays and deductibles, but for the majority of families and individuals, insurance pretty much covers the bills and we remain blithely ignorant about what our health care actually costs.

Continue reading

HealthCare Savvy: New Social Network For Patients

By Martha Bebinger

Next time you visit a doctor, hospital or lab, try asking, “How much does this MRI, blood work or cast on my daughter’s arm cost?” Health care may be the only service we spend money on without having any idea how much the test or procedure or medicine costs. That’s a problem. If we don’t know how much we spend, or if we’re getting good results for the money, it’s going to be hard to tackle rising health care costs.

Asking “how much does it cost” is a new conversation for most of us whether we are patients, nurses, doctors, lab techs or pharmacists. We want to hear what happens. So we’re starting a social network, sort of like a Facebook group, for patients who shop for health care. We’d love to hear from you at Tell us your story, read about other patients’ experiences, browse our list of sites that might help you make smart choices or get tips on asking about the price of your care.

(The point here is not to be confrontational. Some doctors would prefer not to consider costs in deciding what’s best for a patient, others think about what’s a cost-effective approach. Many, like us, just don’t know how much anything costs. So we have tips on how to ask about costs while getting the best care as well. And we have a resource page with suggestions about where to find cost and quality information.)

We’ll share some of your stories on the air. All of them will help us understand your voice in this ongoing debate about how to make health care better and more affordable.