Jane's Place

It's been a while since I went to school for medical billing, but I clearly remember being taught:  "It is the medical billers who know the ins-and-outs of defrauding insurance companies, that earn the largest salaries."    A medical biller that knows how to "up-code" can earn 90k a year, as opposed to the entry-level biller earning 25k. 

Every doctor visit is coded as a level 1, level 2, level 3, as well as procedural coded.  For example, a level 1 visit might mean the doctor didn't see you, only the nurse.  But the medical biller writes level 2 or 3 on the chart anyway, to get the doctor paid much more money from the insurance company.

Another example; a patient goes to a doctor because he wants to lose weight, but the doctor knows his insurance won't pay for that reason, so he writes "respiratory infection" on the chart, and treats him for weight loss.

In this course, the teacher emphasized:  "It is illegal to defraud medicare or medicaid, because they are governmental--------however it is not illegal to defraud all other private insurance companies; only unethical"   "Knowing how to upcode will make-or-break the doctor."

When I learned that medical billing is partially about fraud in my 10-week course, I decided not to go into that field, and went into mortgages and real estate instead.   Not that my industry is free from fraud, we all know thats not true, but at least I have some control, so it doesn't happen in branch office.  My mother didn't offer me a lot of advice growing up, but I do remember her saying:  "If you do everything honestly, you never have to worry about anything coming back to you."   I think that's the best advice you can give a child.

I  think a good way to keep healthcare costs down, would be to have the patient sign-off on the chart to verify what was done, and explain the level 1, 2 or 3 codes to the patients.   In my opinion, this is a big portion of the health insurance money leak, that can be fixed.

Jane