Pratter Blog

You Can't Discount a Revenue Code...

  • by Bill Hennessey M.D.

  • January 21, 2020

and it is causing self-insured companies to pay half of their medical bills blindly.

Example:

Revenue code:
0420 physical therapy

CPT code:
97124 massage
97110 therapeutic exercises
97116 gait training

So a revenue-coded bill comes in for 0420 for $10,200. This is happening. Which CPT code above is this a good deal for? Answer: none of them. Revenue codes skirt billing scrutiny with intentional ambiguity. 0480 means "cardiology." Was the $30K bill for a stress test or an open heart surgery? You don’t know. You just pay.

0300 means "something happened in the lab", yet we all know there are $5 and $500 lab tests. It gets this brazen when employers don't look at their medical bills before or after they pay them.

For an employer spending $100M on healthcare, chances are $50M is going out the door blindly. Who wants to be better?

Contact Mark Robinson mark.robinson@pratter.us to get your Pratter Report for your health plan spend. We diagnose and treat.

A “Copy and Paste” Letter for your Medical Records courtesy of Pratter

  • by Bill Hennessey M.D.

  • January 28, 2020

RE: MEDICAL RECORD REQUEST

To Whom It May Concern:

I request a full copy of my medical records, including those of the hospital and the doctor, including all of the doctor’s orders, especially blood work orders.

Once you provide these to me and I get to compare them to my itemized medical bill, I will consider payment. If I do not receive the doctor’s orders, I will request all of my medical records again. You are encouraged to be thorough and timely if you want paid in a timely manner.

I will wait to hear from you. Thank you in advance for your cooperation.

Sincerely,

The Bull

Remember, don’t be bullied. Be the bull.

FYI: send to ATTN: medical records department

Co-pays and Coinsurances are Dumb

  • by Bill Hennessey M.D.

  • February 23, 2020

All these do is make purchasing health care more confusing. If a health plan wants to sell more product, get rid of co-pay and coinsurance. Go ahead - adjust the deductible. Now you made it easy to understand. People buy more of what they understand. How about a health plan with a $1,500 deductible and from $1,501 onward the care is covered by insurance? Pretty easy to understand. Do not let others limit how you think. Logic is permitted.

Happy Pratterday.

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