Saturday, November 1, 2014

Weekly Whine: Waste

I'm embarrassed to tell you how much of my day is spent in documentation. There are some moments during every day when I feel more like a secretary than a physician. But it's important to do, not just to communicate information and to cover my ass but also for the sake of reimbursement. In order to bill for my time, I have to document a certain way.

There are times when I get pissed off about the fact that I have to do all this documentation. Don't insurance companies trust me? I'm very honest. Then I hear a story like this:

A cardiologist told me that back in the "old days", he used to bill for reading arterial blood gases. Every time a patient on his service had an ABG, he would "read it" and then bill some ridiculous "reading" fee. He apparently made a ton of money doing this.

I have heard dozens of similar stories about the crazy things people used to bill for in the "old days."

Older generations of doctors: you ruined it for the rest of us.


  1. There are still quite a few out there the legal profession (including some judges) are sorting out and punishing the quacks who align themselves with unethical plaintiff firms and billing through the nose to "read" xrays and scans and making shit up to "assist" with toxic tort litigation (silica cases, asbestos cases, etc). They are getting busted, albeit slowly, and generally not before they scam the system for millions apiece.

  2. Its not just that, its the fact that you find so many stories of doctors who didn't police themselves, medical boards not doing so, that its now coming back to haunt the profession. Keeping silent due to retaliation and 'there but for the grace of God go I' no longer work for the internet generation.

  3. It is still going on. I went to a pulmonary doc for evaluation for asthma. He billed for counseling me to lose weight (he did not) and to not resume smoking (he did not and I quit in 1987). When I returned for the results, I told him DO NOT bill for those two items, he mumbled under his breath as he checked off those two boxes again.
    Told my PCP she might not want to refer to him again and I was never returning. Don't need one any way, as I kept telling her, and him I don't have asthma!

  4. All of the above is mostly the product of third party payers. Physicians and hospitals who would not bill their patients for questionable or fraudulent services will readily bill a third party for the same items, partly because the third party is faceless, and partly because the third party only pays half the bill anyway.

  5. It still happens. Just recently received a bill for a copay for a level 5 visit at my PCP. It was a routine annual physical, I don't have any medical issues, I'm not on any medications, and the visit was no more than 10 miunutes. I was outraged because in my mind this is clearly fraud. However, I talked to another doctor at the same health system and he said it's rampant. There is a huge % of level 5 visits in this health system because of all the pressure put on the docs to bill for level 5. And it's really not just this health system. Made me sick to my stomach.