Upcoming Coding Changes Can Create Confusion

March 31, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care

As Americans continue to absorb the healthcare reform and projected modifications, the federal government is updating the way that medical services are coded and billed to consumers. The first mandate is HIPAA 5010, which is an update to the existing HIPAA format and the healthcare information processing systems. 5010 compliance is currently set for July 1, 2012. This will be followed by implementation of an updated coding system, ICD-10, which is to be effective October 1, 2013.

The existing coding system has approximately 13,600 codes while the updated system will have approximately 69,000 codes. The detailed coding system will allow for better analysis and treatment outcomes while providing payers with an initial claim submission that is much easier to understand. However, you may find interpreting your medical bill to be even more confusing as you may see more line item charges.

An example of this was recently reported in a Pennsylvania’s Fox News story. The patient was charged for an office visit and on top of this, she received a separate charge for a “consultation” when the doctor advised her to quit smoking. One thing that these new consultation charges will make clear is that medical care is not like any other product or service. Patients will usually not request additional consultation, and when it shows up in their bill, it seems to represent a service that has been forced on them. Similarly, patients don’t choose where and when to be sick, and when they are hit with high out of network charges or excessive medical bills, this is another example of out-of-control billing that is virtually unavoidable.

By contrast, consumers can avoid expensive charges for other products and services simply by delaying purchase or going without. Going without healthcare, though, is something that governments and other organizations don’t want to see happen, and that’s why legislators are looking at limiting the ways that healthcare providers can bill for services. Still, while there is some help available from medical advocates and others, patients and families need to be vigilant about what they are charged by a healthcare provider, and they need to have frank discussions with their doctors up front to determine how much they will be charged for a specific treatment or consultation.

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