The very simple answer is: they can. If they were not able to get what they bill for,they would not bill that. There are federal codes that assign a numerical resume ration to a billable diagnosis. For example, you can bill a physical yearly exam and the top remuneration may only be 200 dollars, no matter what you charge that is only what the insurance co or Medicare etc will pay you. You bill for anesthesia, and the top may be 10,000 dollars. Interestingly, ED docs which save lives, stabilize and are expected to figure out a diagnosis in 10 minutes are rather poorly reimbursed. It’s the system and it has some big flaws.