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  • D. Maurice Kreis

Dial C for Coding: Season 2 Preview

I won the battle with Dartmouth Hitchock Medical Center (DHMC) and its "revenue cycle performance solutions"co-conspirator Conifer Health Solutions. But, DHMC and Conifer have made clear, the war continues. And it's not just a war with me but with all of DHMC's patients.

To recap, the war has to do with coding. As Dr. Elizabeth Rosenthal cogently explains in her book An American Sickness, these days hospitals employ armies of coders whose job it is to figure out how to translate doctors' notes into billing charges, each of which is associated with a specific code. That, I presume, is what DHMC means by "revenue cycle performance" -- squeezing as many billable charges as possible out of every single inpatient or outpatient interaction.


As noted in my previous "Dial C for Coding" posts (titled so as to make a not-so-subtle point about a hospital with "Hitchcock" in its name -- though it's really hospital namesake Mary Hitchcock who should be rolling over in her grave over this stuff), according to my health plan with Anthem Blue Cross Blue Shield, my annual physical is supposed to be completely covered -- no copayment.


So, when DHMC tried to collect a $30 copayment from me, I squawked. At first, DHMC and Conifer dug in, arguing that because I had somehow strayed beyond the bounds of an annual physical I was susceptible to a copayment.


Oh really?, I replied. Show me the codes!


That's when DHMC and Conifer caved.


Presumably writing to me from the hollow tree that serves as Conifer's headquarters, here's what the billing elf "Kristy" had to say:


"I have reviewed your account with management and the copayment of $30.00 has been adjusted."


She didn't really explain why my account was "adjusted" because, in fact, she noted that DHMC and Conifer were actually sticking to their guns, viz: "A coding review was completed on your account and determined to be correct as is. There was a charge for your annual physical exam which had been paid in full by your insurance as well as the additional visit charge in which the insurance left a copayment."


After apologizing for the "inconvenience," Kristy said she would be mailing me a billing itemization -- and she closed with this warning: "Please be advised going forward any topic outside of the annual physical guidelines will lead to a split visit charge."


Here's what I had to say in reply: "Thank you for reversing the $30 charge. As for the future, please provide me with a list of the the topics that trigger additional charges and at my next annual physical I will hand that list to Dr. Ben [that would be my physician, the capable and friendly Benjamin Geishauser, D.O.] and ask him to avoid those subjects. If that's the way DHMC wants to deliver primary care -- well, that, too, is on you. I think DHMC should be ashamed of itself."


Kristy's response, on behalf of DHMC:

And here's the itemization that I received via an army of specially trained federal agents ( the U.S. Postal Service):

Ah hah! You can see that it was those code 99396 charges that were the culprit -- "topic[s] of discussion" that were "specific to [me] and not everyone in [my] age group." This kind of "revenue cycle performance" management goes straight to the heart of what's wrong with healthcare and the way we pay for it.


I could have afforded to fork over the 30 bucks, but none of us can afford to let this paradigm govern the way we receive our healthcare. I'll be back next year, asking at my annual physical for a list of topics I should not raise. Meanwhile, this whole mess is a reason to mass at the gates of the Bastille with torches and pitchforks.

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