Hospitals grab at least $1 billion in extra fees for emergency room visits

NOTE- this is an excellent, but very long article.  To read the article in its entirety click on:  http://www.publicintegrity.org/2012/09/20/10811/hospitals-grab-least-1-billion-extra-fees-emergency-room-visits

Hospital billing of the two most expensive emergency room codes — 99284 and 99285 — jumped while less expensive codes — 99281 through 999283 — dropped off. The billing codes represent the varying levels of hospital resources required for different types of care; the codes call for payments ranging from $50 to $324, and come on top of physician fees. The codes were developed for physicians, not hospitals. Yet Medicare’s administrator has balked at implementing uniform standards governing how hospitals determine which codes to bill. Instead, Medicare relies on hospitals to set their own internal rules.

Emergency Room Visits Higher-numbered codes receive higher payments from Medicare. Percentage of visits charged at higher-level codes 9928499285‘01‘02‘03‘04‘05‘06‘07‘080%10%20%30%40%
Percentage of visits charged at lower-level codes 992819928299283‘01‘02‘03‘04‘05‘06‘07‘080%10%20%30%40%

 

Medicare has emerged as a potent campaign issue, with both Barack Obama and Mitt Romney vowing to tame its spending growth while protecting seniors. But there’s been little talk about some of the arcane factors that drive up costs, such as billing and coding practices, and what to do about them.  Our 21-month investigation documents for the first time how some medical professionals have billed at sharply higher rates than their peers and collected billions of dollars of questionable fees as a result.