| > I really wish I could find out the answer to how this works It's billing code optimization. Doctors aren't specialists in billing/diagnosis codes, and their time is really valuable, so many of them tend to use a handful of fairly generic defaults they're most used to and then move onto the next patient. This is what you paid when you left. There are really, really specific requirements for many billing/diagnostic codes, which will each have a fee defined against them. If a code requires a specific question to have been asked or a specific set of actions to have been performed by the doctor, if even the most minor component is missing it risks having the claim rejected[1]. Or more specifically, if it's missing _from the doctor's notes_[2], such that there's no documentation that it was done/asked, then it risks being rejected. An asynchronous process got kicked off after your visit, where your visit details went into the queue for either a medical coder (either human or software) to review visit details, prognosis, and doctor notes. Then, based on their findings, they adjusted the code your doctor originally used (either changing it entirely, or adding supplemental codes). That's why you got an incremental bill at the end. [1] This is in the case of insurance companies. If a medical practice wants to charge for a code, the insurance company demands the requisite documentation to justify the use of that code. I've never tried it, but you may have some success disputing the bill by _also_ requesting the specific diagnostic codes that led to the incremental bill, as well as the supporting documentation to justify the coding. Which is what an insurance company would do, too. [2] This is one of the big benefits of an EHR to a practice. The EHR workflows can be set up to require a bunch of boilerplate information be collected and processes be followed, which generates very rich visit notes and provides a lot of opportunity (and documentation to justify) for upcoding a visit. Which usually makes administrators/practice managers happy, while mildly annoying physicians. |