I recently started to educate myself on what facility charges are and how they work. They are not only method of billing and coding (virtually a loophole at this point) that allows doctors who are affiliated with a hospital to charge DOUBLE for a service at the clinics they work at.
I see a sleep specialist who works out of the clinics at the largest hospital in my state. He is the only sleep specialist in their network (possibly the only one nearby and that my insurance would cover, but that’s a separate issue). His office is able to code my visit with the codes for TWO visits simply because he works for the hospital.
This second code is called the facility charge. As far as I can tell, it isn’t really limited or controlled beyond not being able to be more than the visit itself.
So, even though it may be more expensive to have an in-depth problem assessment visit, where we need to change my meds, meet for an hour, and discuss lab results, they can still charge a higher facility charge even though the amount of effort needed by the nursing staff is the same as a 15 minute annual check up visit.
Furthermore, doctors in clinics who are NOT affiliated with hospitals - like a private practice doctor - can’t charge this facility charge. In the case of these clinic visits, how can you argue it makes sense then to say that a patient needs to pay for “facility” related things when they are at a clinic located inside hospital but not at one elsewhere?
I truly believe this is a place to start with healthcare reform. A service should only be able to have a single code applied to it - there shouldn’t be additional “hidden fees” depending on the location you are at.
The price of that service can differ, and they need to be clear about that up front - basically say “depending on how complex your visit is, it will be considered as one of these 5 services ranging in price from x-y”. In the CPT codes that are used in healthcare and by insurance, each are defined by the activities completed to consider a service rendered (to be a level 2 appointment for issue x, the doctor must meet with the patient for at least this many minutes, get a detailed health history, etc.).
TLDR: Facility charges let doctors affiliated with hospitals working at their clinics effectively double charge, it seems very shady and unethical, there is a pretty straightforward way to provide clear pricing and billing with existing medical codes. We need to ban these hidden fees in healthcare.
0 nhận xét:
Đăng nhận xét