Audit: Essentia Health of Duluth overbilled Medicare
September 26, 2012 at 3:34 am in Duluth News Tribune
Essentia says it has refunded more than $865,000 in Medicare overpayments. Continue Reading
Audit: Essentia Health of Duluth overbilled Medicare
2 Comments
“Minnesota Public Radio News reports Essentia billed Medicare $3.18 for every dollar the hospital system was owed.”
That is a standard across the board in medical billing.
Services are billed using code designations that almighty FedGov determines. Say if St. Mary’s puts a cast on my leg, the code for doing so might be ABC123. The billing people will then use that code in the writeup of my bill to Medicare (were I to be on it).
The fault then lies not with St. Mary’s, but with Medicare. If code ABC123 is designated to pay $100, and St. Mary’s charges $1000, it should still only pay $100.
From a billing perspective it’s a lot easier to go with a nice flat rate per charge, instead of trying to constantly keep up with changes that are made to the codes. If overpayments occur, and coding has been correct (as opposed to say, billing Medicare for an MRI when all you did was give a flu shot), then the question is why are Medicare’s codes paying more than should be designated?
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That’s nice, they bill in code so you don’t know what any of it means. I wonder how much they’ve over billed me? And that big of a discrepancy, it’s pretty darn fishy to me.
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