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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.”
(Score: 1, Insightful) by Anonymous Coward on Tuesday May 05 2015, @06:15PM
Now before you start jumping down a hospital's throat - often these errors happen because of lack of staff training, staff laziness,etc and not actual malice.
That malice comes in at the higher level where management decides that they don't need to invest in correcting those problems. It is sort of a malignant neglect - since the errors are generally in their favor, they get more money by leaving things the way they are and forcing patients to choose between a long drawn out fight for an honest bill or just giving up because they don't have the time and energy. Cell phone and cable companies are notorious for a similar sort of behavior simply because they can get away with it since they face so little competition.
(Score: 0) by Anonymous Coward on Tuesday May 05 2015, @06:42PM
It goes further back than that. This sort of error happens all the time because it is BUILT IN.
I used to write software that did this. Ask your doctor about standard procedures. Basically you come in for X. The computer then decides you need Y and Z (because standard...). Even though you may never do Y and Z. It just automatically does it. I would bring it up in our daily meetings while making the software that seemed 'shady' I was told 'its what our customers want'.
This doctor knows the real system. Which is not in any way the same system as the billing system. Which is why he asks for that chart as the chart knows all. The doctors and nurses are doing the right thing. The front office though is there to get money.
I called it insurance chicken. Basically submit all the data. Hope it gets paid. If not flip it to the guarantor. If that doesnt work flip it to collections or just tax deduct it. No one cares because 'the insurance pays for it'. We even passed huge 'healthcare bills' that are nothing more than mandated insurance.