Countersign Medical Invoice Made Easy

Countersign medical invoice

so we're going to talk about medical bills and what happens to bills after you give medical care so let's say we have a patient I've had to go to the hospital maybe that patient I herniated disc and that disc was fixed and it goes home and then walks to the mailbox one day and in the mailbox comes this medical bill if you ever seen a medical bill they can really kind of confusing and intimidating you have line items of all these things that could happen in the hospital hard to make sense of that but let's try to let's try to go ahead and do that well first of all let's consider well what what's on this bill so maybe if you took a pill that you that'll be on the bill perhaps our patient had some x-rays as well and so those will appear on the bill in addition to the x-rays our patient was probably cared for by a nurse you know took blood pressures and kind of checked our patient periodically maybe our patient also had to stay in a hospital bed for a few nights so that's going to also um be added to the tab all these things are going to deal with the hospital based care all those items that can occur and then there's also gonna be doctors to see our patient so maybe there'll be an internist who kind of comes in listens to our patients heart and lungs we're going to have a neurosurgeon who has to actually remove that herniated disk so so we'll just consider that there's all these little things and they all appear on that hospital bill and each of those is going to be given a price and it's going to be listed individually and this is sort of the essence of what's referred to as a fee-for-service system every little thing on there gets a little price well now how do we actually ultimately really pay for this and so I'm going to sort of um explore this in a couple of options the first method might be if our patient had Medicare the government program that offers medical insurance and paste or medical care usually for the older population on the other hand our patient could also have ivenn insurance and so we'll talk about how that would handle this bill as well let's go ahead and first start with Medicare and right off the bat Medicare does something very helpful in simplifying these bills they take all of those goods and services that are part of just the hospitalization you know maybe the cost is the bed the cost of nursing care you know people in move around in wheelchairs maybe some of the medicines x-rays and they bundle all that together into what's called a diagnosis related group or a DRG that's essentially a bundle of services and it depends on what's wrong with the patient so every medical problem like if you have maybe you had a baby or you broke your leg or like this patient you had a back surgery to take out a herniated disc there's a certain price that's assigned to that and that's supposed to cover everything that's done to you in the hospital so I don't know so I'm just going to make this something suppose for having a disc surgery that's like $3,000 that's a fixed price that Medicare is set that's how much they're going to pay that also to be clear I'm just going to put this in green that part of Medicare that covers the hospital DRG is called Part A of Medicare now you'll notice that didn't include the doctor so let's talk about how they're paid for and to be honest it's actually kind of a little weird and kind of interesting well in the 1980s a group of people got together and they made a list I'm just going to draw a little book here of all the different things doctors can actually do I mean like read x-rays do surgery um you know read an electrocardiogram set a broken bone they made a list and they made this book and you're listed almost 8000 different things doctors could do and they gave each of those things based on the difficulty of doing it and how much training it was how much time each of those was assigned a number called a relative value unit in other words if you read a chest x-ray that was given a relative value unit of 0.2 if you were doctor if you did a colonoscopy that was given relative value in fc6 if you talk to a patient for a while and explain something to them that's called the e/m evaluation and management code a certain type of visit you might get to our views back and all the way down the list as I said to almost 8,000 different things doctors could do well so I said well how do they come up with that bill so they actually take every little service your doctor did they take all those little things like maybe you had surgery maybe they did a colonoscopy maybe they had to read a chest x-ray all those services they add them all up you get the total number of our B views from that hospitalization they take that number they multiply it by something called the conversion factor which is approximately $40 and so they take all the our views they multiply by the conversion factor and that gives you your doctor's bill that doctors bill I'm going to put it in green here is typically paid for by Medicare Part B so generally speaking if you go to the hospital there's going to be Medicare is going to take care of that bill pay a DRG to cover Part A the hospital services and then pay your doctor as well and then as a patient you'll have to pay some percentage of what's left and so as a patient you have to then pay a copay along with that but one of the really nice things about Medicare is that by bundling services together like this by assigning value to the physicians there's nothing for patients to worry about in terms of bargaining for prices the prices are fixed so on a point that I'm very clearly that with Medicare there are no negotiations between the hospitals and the federal government because Medicare is such a huge buy or all those medic goods and services they kind of just set their prices and doctors take them it's often one of the cheapest ways to get medical care because Medicare has very low prices though I'm not focusing on it much now Medicaid works quite similarly to Medicare it also has non negotiated prices however these prices are often much lower than they are for Medicare because states often set very low prices as a result some hospitals or providers may choose not to participate at all in Medicaid going to switch gears now we'll talk about private insurance suppose our patient got private health insurance well you know it's kind of similar private health insurers also have these bundles of DRGs they also have physician prices but the key thing about private insurers is that unlike Medicare which has fixed prices almost doesn't matter where you go the private insurer has to make an agreement with the hospital and doctors they have to negotiate and create a contract for services so you can imagine what that leads to if you have to make a contract you can get very different contracts between your insurer and the hospital depending on where you live let me explain it in this way suppose you live in an area where there's like lots of hospital so I'll just say there's three hospitals in the area where the patient lives and where the insurance company the private insurance company does business so that insurance company may go to those three hospitals and say well we want to get your business let's negotiate some prices how much you got to charge us for all this list of goods and services and so has this hospital may say okay we'll charge you a lot this hospital says hey you know we want some business we're going to charge a little grass and this one says yeah we want some business so we're going to charge a little bit look at what's happened because of that comp tician the overall price there's negotiate it's going to be lower not only that the insurer is going to say well oh these are the hospitals we want our patients to go to so what we've done is we've created a network so if you are a patient and you need to have that disc surgery you go to a hospital in your network and then your insurer who has made these special deals gets the discounted price for those surgeries they hopefully it's a good price on the other hand if you go out of network to this hospital that's going to be a higher price in your insurance company's going to say we're not going to pay for that we never made a view with them you're on your own so with insurance companies you have to say in-network and the reason they make those networks is so they can try to negotiate good prices now here's the thing though maybe there's only one hospital you live in a remote area you can't negotiate with just one hospital they'll say you don't want it your patients come here forget it where you going to take them you got to pay those high prices so with private insurers the price you pay Oh vary a lot so New York City might have very very different prices than Massachusetts they have very very different prices than California they have very very different prices than Oregon it all depends on the size of the private insurer side the amount of competition and what kind of deal they can get and that's why you get all these issues where you have networks and private insurers are very clear about where you can and can't go we've talked about both Medicare as well as private insurers but let's not forget there's a third category as well and those are people who are uninsured or they pay all their expenses out-of-pocket what happens to them well they actually have the hardest and worst deal of all remember how we talked about how you have all these little prices here Medicare and private insurers bundle a lot of that together and they have these sort of negotiated prices uninsured people have none of that so that bill you get you get a list every single line has a different price and not only that those prices can be very high because hospitals have often just made those up those prices are listed in something called the charge master and that charge master is the master list of prices and they're very high it can be like $8.00 for a pill of Tylenol like $100 for an x-ray and all those charges get added up into a big bill one of the great difficulties of being uninsured is not only do you not have a insurance policy that covers you but the actual prices you pay are very very high compared to private insurers and Medicare so the highest prices are paid by the uninsured so I'll draw that up here the lowest prices are paid by people on Medicare and private insurers are somewhere in between anyway that is a little bit of an introduction to what happens to your medical bill