Stories
Slash Boxes
Comments

SoylentNews is people

posted by CoolHand on Tuesday May 05 2015, @05:12PM   Printer-friendly
from the are-the-codes-secret-are-they-safe? dept.

Elisabeth Rosenthal writes in the NYT that she has spent the past six months trying to figure out a medical bill for $225 that includes "Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others" and she really doesn't want to pay it until she understands what it’s for. "At first, I left messages on the lab’s billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: “I’m sorry, this is what I’m told, and I don’t want to lose my job.”" Bills variously use CPT, HCPCS or ICD-9 codes. Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all. Heather Pearce of Seattle told me how she’d recently received a $45,000 hospital bill with the explanation “miscellaneous.”

So what's the problem? “Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that,” says Mark Hall. “We’ve not seen a lot of pressure to standardize medical billing, but there’s certainly a need.” Hospitals and medical clinics say that detailed bills are simply too complicated for patients and that they provide the information required by insurers but with rising copays and deductibles, patients are shouldering an increasing burden. One recent study found that up to 90 percent of hospital bills contain errors and an audit by Equifax found that hospital bills that totaled more than $10,000 contained an average error of $1,300. “There are no industry standards with regards to what information a patient should receive regarding their bill,” says Cyndee Weston, executive director of the American Medical Billing Association. “The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry.”

 
This discussion has been archived. No new comments can be posted.
Display Options Threshold/Breakthrough Mark All as Read Mark All as Unread
The Fine Print: The following comments are owned by whoever posted them. We are not responsible for them in any way.
  • (Score: 1) by AlphaMan on Tuesday May 05 2015, @05:33PM

    by AlphaMan (5223) on Tuesday May 05 2015, @05:33PM (#179168)

    The abstract states that there is an average $1,300 error in a $10,000 bill but it would be illuminating to see the distribution of these errors: are they random or not?

    Years ago, I worked at a proprietary trading firm that carefully scrutinized its broker-dealer invoices. Interestingly, the errors were not at all randomly-distributed - they nearly always favored the broker. Go figure.

  • (Score: 1) by Paradise Pete on Wednesday May 06 2015, @06:06AM

    by Paradise Pete (1806) on Wednesday May 06 2015, @06:06AM (#179403)

    it would be illuminating to see the distribution of these errors: are they random or not?

    Even without any intentional bias, errors of omission would be difficult to detect. So wouldn't the known errors will skew to the high side, even when the true error distribution is random?

    • (Score: 1) by AlphaMan on Friday May 08 2015, @04:03PM

      by AlphaMan (5223) on Friday May 08 2015, @04:03PM (#180355)

      I see your point. The article does say that double-billing is the most common form of error but provides insufficient detail to determine if the auditors were able to catch errors of omission.