GenMassachusetts-L ArchivesArchiver > GenMassachusetts > 1999-04 > 0925061592
From: William Hoisington <>
Subject: Re: Causes of Death
Date: Sun, 25 Apr 1999 13:33:12 -0400
Having worked in health care, and dealt with the bureaucracies of billing
insurances including Medicare, I have had the experience of "finding" a true,
billable diagnosis to receive payment for physician services.
Often, simply listing the condition, i.e., "stroke", is not a reimburseable
diagnosis. Say, for instance, that the cardiologist is treating the patient for
stroke and bills that diagnosis, the family physician cannot bill the same
insuror (let's say Medicare) for that same diagnosis on the same day. Both
specialists may have visited the same patient but only one is viewed by Medicare
as treating the patient for stroke, and in many cases it's whoever gets their
bill to Medicare first.
Therefore, the family physician may actually prescribe a regimen for stroke
reprecussions (and not in duplication of the cardiologist's efforts) but bill
for a related condition (elevated cholesterol, for instance). It is a
circuitous way of dealing with enormous bureaucratic and idiosyncratic insurance
systems. Oftentimes it's the billing staff between offices who communicate back
and forth -- when was the patient seen? What diagnosis did you use? Did the
physician document in the chart other conditions? How many providers are
involved? For stroke a patient may be seen by his family physician, an
emergency room physician, a neurologist, a cardiologist, a radiologist, an
occupational/ physical/speech therapist, and in cases of surgical treatment
(like cleaning out the carotid arteries to prevent future strokes), a vascular
surgeon, an anesthesiologist -- all of whom are legitimate providers of care and
all of whom may consult and evaluate the patient on the same day!
I've seen some bills rejected by Medicare if the patient is readmitted within a
certain number of days after a discharge for the "same" condition -- like two
strokes in a month, or uncontrolled diabetes. Most physicians aren't padding
the bill -- their service expenses are dictated by Medicare down to the penny
and then reimbursed at 80% of that figure. The final cause of death may indeed
be the fact that the patient stopped breathing -- insurors just figure that the
patient should have been treated by only one provider per day, regardless of the
complexity of the diagnosis and treatment regimen.
> Not only old but as recent as 1983!!!
> My late mother and I were curious as to what would actually be on my
> father's death certificate. Well, when we received our copies several weeks
> later it gave us a good laugh. The techincal cause: Respiratory arrest.
> LOL he stopped breathing!!!!! Now that took a medical genius on the hospital
> staff to come up with that after his 3 week stay in the hospital in a coma
> from stroke they misdiagnosed!!!
> -----Original Message-----
> From: <>
> To: <>
> Date: Sunday, April 25, 1999 4:07 AM
> Subject: Causes of Death
> >I would just caution people about the Causes of Death in old death