Great post, and I appreciate your follow up posts as well. I work for a hospital as well, in Periop IT, supporting Epic and surgery billing. And yeah, spot on, it's a game played by hospitals and payers about reimbursement details. Coding has to be done on the surgeon's opnote, regardless of what was scheduled as the diagnosis/hard-coded procedure, pre-auth or not. And it's tough because it's only as good as the documentation. We try to emphasize to the nursing staff and OR Team Leads for clinical review to make sure the log gets changed to what was actually done.
It's been super eye-opening all these years in this job though, the system sucks, plain and simple. It's amazing to see what gets written off too.
It's the only field where ball park estimates may be completely off, especially in surgery, it's dependent on the particular surgeon, how fast they are (as it's OR minutes billed), what they like to use, and what's actually going on where they open as you said.
Luckily, our benefits are still really good. Still need to be in the system, but that's the one shining part of it. They've stripped away our rollover PTO though, we used to be able to bank 480 hours and carry them over every year, it's much lower now. And we used to be able to pay our benefits from that bank. That was amazing. They took that away too.
US healthcare needs an overhaul. It's frustrating to people and not explained. People get bills from the surgeon's pb portion, the hospital portion, anesthesia companies, and other misc stuff for the same encounter.
We've been through that too with NICU stays with my second child. At least I was familiar with the system for less shock.
Edit- I didn't talk about the markup policy for supplies and implants. It's HUGE. I'm not talking bandaids or tape, anything under 10 bucks doesn't get charged as it's rolled into the room time, but it's a lot.
But again, part of the game between the hospital system and the insurance companies.
