Medical Billing Problems Part I
In case it has been awhile lets do a fast review: charges on your bill mostly come from an order given by a physician for your treatment. If the charge is a supply item it may appear on your bill in a variety of ways. Some facilities use stickers affixed to a “charge card” others use a scanner. Or maybe another way is used, but somehow that item shows up on your bill.
So why do you read and hear about stories of millions of dollars in hospital overcharges? That is what we will investigate in part I of the problem, human error.
Everyone makes mistakes and that happens when entering orders as well. Perhaps the date is wrong or the test is not exactly what the physician ordered. In short, anything could and probably does happen.
From personal experience I can tell you I have been called by lab, radiology, pharmacy and even dietary questioning about an order in the computer. Fortunately not all in the same day on the same patient. Just recently lab called about an order, a magnesium was scheduled to be drawn even though one had been done earlier in the morning. Since there was no order, I canceled the new one.
I have been in situations where a lab or x-ray was needed immediately. In those cases the department will render the service and will ask you to put in the order later. Even a reminder if it is forgotten. Patient safety is not at risk just because an order is not in the computer.
So is the order always placed in the computer? After the situation is more calm then we all try to catch up and put in missing pieces. But sometimes things are missed.
Hospitals may use other safeguards also to ensure orders are placed. Some hospitals require physicians to enter their own orders. This procedure takes care of several steps. And would hopefully cut down on errors. In all hospitals I have worked at, nurses are required to do a chart check, maybe a twelve hour check or a twenty four hour check or both to make sure orders are entered and completed.
As for supplies, I can give you an example. One night I was particularly busy tending to 2 ill patients. Running from task to task to make sure each had proper care. When I finally sat down I stickers from supplies all over my uniform top.
So to make things right I had to put the proper sticker on the proper “charge card”. I think I did just that, but with the hectic work load stickers maybe misplaced.
Even well intentioned actions intended for comfort of the patients can lead to unforeseen consequences. As I have said I have worked in a variety of care setting. This example took place in the Neonatal ICU. There we routinely put small fleece squares in the bottom of the isolette to prevent skin breakdown.
It just so happened that the fleece square affected the x-rays on some of the babes. In some cases the x-ray appeared more patchy, it had more white space. So unintentionally this comfort measure was actually counter productive. A clever physician figured out the cause and it was quickly remedied.
So I hope you can see how human error can contribute to hospital and medical bill errors. I have given several examples how they may occur. The next part will deal with a different kind of error however.
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