Understanding and predicting medical expenses is one of the greatest challenges of
modern times. Health care in the United States is governed by a series of codes: the ICD-9
(International Statistical Classification of Diseases and Related Health Problems). The
codes are also used as diagnosis codes to help relate and determine the path of treatment
and the billable expense for the medical professional. Coupled with the ICD-9 codes are
the CPT codes (Current Procedural Terminology) which are a series of numbers that relate
to the medical (billable) procedure(s) performed.
Medical coding, is the process of transforming descriptions of medical diagnoses and
procedures into universal medical code numbers. Diagnosis codes are used to track
diseases, whether they are everyday diseases such as diabetes mellitus and heart disease,
to contagious diseases such as norovirus, the flu, and athlete's foot. These diagnosis and
procedure codes are also used by health insurance companies and workers' compensation
carriers.
Individual practices and insurance companies also have procedure codes that pertain to
specific aspects of exams and procedures. The expenses are related to the codes but are
additonal charges the physicians or practice collect for the indivdual services the doctor is
seeing you for, ie: physical exam or an endoscopy. These two codes are combined and
you recieve a bill based on these codes. The bill is not a simple dollar figure but it is
derived from an elaborate formula that is primarily determined within a medical practice by
individuals termed "coders" based on the physician medicare refere
The coders' main responsibilities are to apply the best codes (allowable by current health
care laws) to either make the practice the most money or allow the insurance company pay
the least money.
HonestMed is researching this topic and is hoping to be able to provide more detailed
information to help patients take educated steps to ensure they are being treated fairly.
One good example is My Health Score This is a very helpful site that will give relative
prices of procedures by CPT codes. Finding these codes is not easy, they are not intended
for the general public. There are sites that will provide ICD-9 codes for diagnosis of which
there are currently approximately 24,000. By 2012 they have proposed to increase the
ICD-9 to ICD-10 codes of which there will be over 207,000. For more information refer to
link: AHIP Press Release
Medical facilities and doctors offices purchase code manuals that cost several hundred
dollars and are updated annually, providing another factor that encourages tight scrutiny
on the code information and added complexity for patient to access these medical codes.
Unfortunately there are no dollar figures mentioned in these manuals. That would be to
simple, this is where the formulas comes into play.
Much like paying federal and state taxes, there are formulas that correspond to medical
expenses and require special pathways to achieve a full understanding and access. We
are working to provide more information and access to this information. Like newly evolved
tax programs that are available to the individuals (ie.TurboTax Medical) that help to enable
and demystify the process. In an effort to complete, companies are developing simplified
programs for patients to get an "up front" handle on medical costs, but again, public
information at a nominal cost in a form that patient can use.
We hope that anyone with information on how to unlock information will contact HonestMed
and help us provide you with links and insight into your medical bills.
From work and personal experience we have been noticing that medical insurance
companies are devising clever get-rich schemes almost as fast as the credit card
companies. By developing loop holes such as ore-determination of benefits, a process
whereby the patient is responsible for reporting a scheduled procedure, one that requires
no pre-authorizations by the medical staff, but easily deniable if not addressed by the
patient.
modern times. Health care in the United States is governed by a series of codes: the ICD-9
(International Statistical Classification of Diseases and Related Health Problems). The
codes are also used as diagnosis codes to help relate and determine the path of treatment
and the billable expense for the medical professional. Coupled with the ICD-9 codes are
the CPT codes (Current Procedural Terminology) which are a series of numbers that relate
to the medical (billable) procedure(s) performed.
Medical coding, is the process of transforming descriptions of medical diagnoses and
procedures into universal medical code numbers. Diagnosis codes are used to track
diseases, whether they are everyday diseases such as diabetes mellitus and heart disease,
to contagious diseases such as norovirus, the flu, and athlete's foot. These diagnosis and
procedure codes are also used by health insurance companies and workers' compensation
carriers.
Individual practices and insurance companies also have procedure codes that pertain to
specific aspects of exams and procedures. The expenses are related to the codes but are
additonal charges the physicians or practice collect for the indivdual services the doctor is
seeing you for, ie: physical exam or an endoscopy. These two codes are combined and
you recieve a bill based on these codes. The bill is not a simple dollar figure but it is
derived from an elaborate formula that is primarily determined within a medical practice by
individuals termed "coders" based on the physician medicare refere
The coders' main responsibilities are to apply the best codes (allowable by current health
care laws) to either make the practice the most money or allow the insurance company pay
the least money.
HonestMed is researching this topic and is hoping to be able to provide more detailed
information to help patients take educated steps to ensure they are being treated fairly.
One good example is My Health Score This is a very helpful site that will give relative
prices of procedures by CPT codes. Finding these codes is not easy, they are not intended
for the general public. There are sites that will provide ICD-9 codes for diagnosis of which
there are currently approximately 24,000. By 2012 they have proposed to increase the
ICD-9 to ICD-10 codes of which there will be over 207,000. For more information refer to
link: AHIP Press Release
Medical facilities and doctors offices purchase code manuals that cost several hundred
dollars and are updated annually, providing another factor that encourages tight scrutiny
on the code information and added complexity for patient to access these medical codes.
Unfortunately there are no dollar figures mentioned in these manuals. That would be to
simple, this is where the formulas comes into play.
Much like paying federal and state taxes, there are formulas that correspond to medical
expenses and require special pathways to achieve a full understanding and access. We
are working to provide more information and access to this information. Like newly evolved
tax programs that are available to the individuals (ie.TurboTax Medical) that help to enable
and demystify the process. In an effort to complete, companies are developing simplified
programs for patients to get an "up front" handle on medical costs, but again, public
information at a nominal cost in a form that patient can use.
We hope that anyone with information on how to unlock information will contact HonestMed
and help us provide you with links and insight into your medical bills.
From work and personal experience we have been noticing that medical insurance
companies are devising clever get-rich schemes almost as fast as the credit card
companies. By developing loop holes such as ore-determination of benefits, a process
whereby the patient is responsible for reporting a scheduled procedure, one that requires
no pre-authorizations by the medical staff, but easily deniable if not addressed by the
patient.
Steps you can take to avoid ripoffs from your insurance and health care providers:
- Keep a notebook and always write down who and when you talked to any one regarding your
health care. - If you are fortunate to have heath care insurance call the service provider number on the cards
and become aquainted with your coverage. - If you get a bill call and inquire until all your questions are answered.
- Make an effort to keep up with your policy and the changes that apply to you.
- Talk to friends and family about their dealing with health issues.
- Learn to utilize the new internet information services available on health care issues like finding a
good friendly reliable doctor, and what to do if they are misserable and provide crummy service or
poor bedside manners. - Become familiar with your local Emergency Medical Services. Call them and ask questions, it is
better to have a fundamental knowlege than be surprised when you need them for an emergency. - Read and seek help understanding the Patients Bill of Rights. Be aware that insurance companies
and medical corporations are developing their own Patient Bills to offset the Federal Governments
version. Don't be intimidated. Learn and know your "Rights!" - HIPPA (Office for Civil Rights - HIPAA) is intended to protect and aid the patient, not to "make your
life hell in getting your own medial records." Investigate and become familiar with what HIPPA
represents. - HOW TO FILE A HEALTH INFORMATION PRIVACY COMPLAINT WITH THE OFFICE FOR CIVIL
RIGHTS - Your doctor is not a "God", they practice medicine, they sometimes get it right but the old adage"
take two and call me in the morning" is sometimes as good a medical treatment as can be
expected. - Common sense and asking questions is sometimes the key to unlocking good health care, and
nothing takes the place of washing your hands with warm soap and water and never share pens
or pencils, most people but them in their months.
Updated 05/15/08
4/21
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