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EPtalk by Dr. Jayne 10/20/22

October 20, 2022 Dr. Jayne 1 Comment


I went to look at the pricing and deadlines for the HIMSS23 conference earlier this week and it looks like they’re doing a little bit of a cash grab in switching up their pricing. It used to be that the basic conference pass, at the lowest price point, included access to the session records. Now you’ll have to pay an upcharge of nearly $300 for that privilege.

In addition to the recordings, the middle price point also includes access to the pre-conference forum as well as admission to the Thursday night special event. The highest price point adds on attendance at the CXO experience and the Executive Summit / Reception. I haven’t done my registration yet, so I can’t see whether there are a la carte offerings for the different items as well, but hopefully I’ll get around to that soon.

Within the last couple of years, I worked for a couple of telehealth companies. Over the weekend, one of them began texting me about surges in patient volume, despite the fact that I haven’t worked for them in months. For a while I was wondering what kind of activity happened on their system that my phone number has come back from the dead, and then it occurred to me that maybe they’ve just had a slow summer and they’re starting to see an uptick in patient requests due to the increase in cases of influenza and other viral illnesses. Regardless of the reason, texting STOP made them requests go away, which dramatically increased my provider satisfaction.

Speaking of satisfaction measures, I recently received a survey from a vendor who knows I’m extremely dissatisfied with their service. I tried to dodge it by ignoring it, but I kept being peppered by requests that appeared to be from the individual service rep, who is well aware of my dissatisfaction. I know about statistical sampling and the need to have an adequate number of responses, but it boggles my mind that they would continue to beat down the door of a disgruntled customer to the point where I felt like providing an even more negative response than I had intended to deliver. I slept on it for a couple of days then finally sent it over, trying to be as fair as possible. I hope I’m tagged in their customer relationship management as being in remediation, and that based on my very pointed feedback, that they reconsider how they’re sampling customers for routine surveys.

One of my friends reached out to ask my opinion on a medical billing situation. Apparently his insurance only covers vaccines when they’re administered in a physician’s office as opposed to covering them when they’re given at a retail clinic. At least in my community, pricing at Walgreens, Target, and CVS are all cheaper than a vaccine at a physician office and are often more convenient for the patient. I tried calling for a flu vaccine for a family member at their own primary care provider’s office, and after several weeks of trying to get through and continuing to be placed in voice mail purgatory, I gave up and took him to Costco for a quick and convenient vaccine. Fortunately it was covered by his insurance, but it just goes to show how off-kilter our current healthcare delivery system is.

Quote of the week: I loved this quote on the recent Monday Morning Update: “It’s a good lesson for vendors who think AI/ML is the universal hammer for all healthcare nails – Epic has 40-plus years of experience working with the best health systems in the country, so if it can mess up a clinical algorithm, imagine the clinical damage your cool startup and its team of former beer-ponging Facebook engineers could do.” I’ve worked on several AI and ML projects in a variety of settings, including academics, startups, and with startups that were spun off from academic medical centers. I’ve found that doing AI/ML the right way is almost universally harder than people think it is, especially if you want to ensure that you’re training your models in a way that avoids bias and works for diverse populations. If you’re like some of my former colleagues who jumped from retail IT to the clinical space and thought they knew it all, I hope you’re employing experienced clinical informaticists to save you from yourself.

This week included some adventures in healthcare, with weirdness on both the clinical and revenue cycle fronts. I had an annual visit with one of my subspecialists, who uses a scribe. Usually I find that it makes the visit more efficient, and this visit was no exception. Since we’re in the era of unbridled data sharing, I couldn’t wait to see what my visit note looked like. At this clinical office, they never take my co-pay and I always wind up receiving a bill, so I tried to pay the co-pay at checkout. They told me I didn’t have one, and I insisted that I did and offered to show them my card that said so. The clerk said she would check in the system and figure it out, then came back with a “definitely no co-pay” verdict. I asked her to check the practice management system, where she’d clearly see my annual visits and the subsequent copay being billed and my payments, but she refused. This is the only office I’ve been to that refuses cash at the time of service, so I’m not sure what era their billing team is living in.

The weirdness continued when I returned home and looked at my visit note, which was already available. Imagine my surprise when I saw the documentation that the patient had completed a questionnaire, including a comprehensive review of systems, and that I had discussed it with the physician, since neither of those events occurred. The templated documentation also noted that the document was scanned, which is interesting because I’ve never completed anything like that at this office. This is the second time this year I’ve been confronted with erroneous visit notes and I’m still wondering what the best way is to handle them. In this case, it doesn’t impact the outcome of the visit or my future care, so I’m not that excited about bringing it up. In the other case, there were material errors in the chart, but I still don’t know the best way to deal with them. I’ve decided to leave that provider’s care anyway, and the errors aren’t anything that are going to impact future care or payments or anything else, but they’re just annoying.

Have you had errors in your visit documentation after seeing a healthcare provider? How did you handle the situation? Leave a comment or email me.

Email Dr. Jayne.

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Currently there is "1 comment" on this Article:

  1. I had a 5 minute followup visit with my urologist who billed a 99215 comprehensive visit. The note documented review of systems and a fairly comprehensive physical exam, neither of which happened. I protested that the note was wrong and that the charge was not justified, Apparently the new AMA rules look more at medical decison making and say that if the provider looks at prior results, does a visit, and orders more tests that this justifies a 99215, and the provider was saying that the coders set the code, not him. After a couple of more exchanges, the PE and ROS were removed, and the billing got changed to a 99214. I would have thought a 99213 or even 99212 would have been more correct.
    This sort of templated note making is just wrong if it is not edited to reflect reality. One has to surmise that overbilling is rampant, and most consumers do not even know what to ask. The EOBs from the carrier only show “Office visit” with no information as to how extensive that might be, let alone the CPT code.

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