Hospital Billing Errors ‘Kill’ Patients

Hospital billing mistakes have become so prevalent that a niche industry has evolved to help patients decipher their bills and help correct the errors. ”Pat Palmer, founder of Medical Billing Advocates of America, estimates that she finds multiple errors in 8 out of every 10 hospital bills she reviews” (Dina ElBoghdady, “Killer Billing Errors,” Washington Post, June 27, 2004, p. F01. Accessed Aug 9, 2007 at: http://www.washingtonpost.com/wp-dyn/articles/A7351-2004Jun26.html ).

One patient saw the bill of $25,652.14 for her 2-hour routine operation, reduced to a cost of $17,000 billed to the insurance company and her cost reduced to $2,148, after correcting errors and overcharges.
While this error-rate was not statistically measured, nor would it apply to all hospital bills, it points out a huge problem in Information Quality in the health care system, not counting actual medical errors caused by information defects.

The consequence of health care over billing is significant. It contributes to the high costs of health care, which is one major cause of personal bankruptcy.
The causes of hospital billing errors are many:
• The complexity of diagnosis codes and health care procedure codes is complex and time consuming
• The practice of billing for every detailed item is very error prone. Items are created for the use of each instrument, sponge, and medication component are difficult to document accurately
• Keying errors in data entry can be quite common
• The ultimate root cause is the desire to increase revenue in health care services leading to poor controls in the billing process

From a consumer standpoint, my recommendations are:
• Always get an itemized hospital or healthcare service bill
• Review it as quickly as possible while the service experience is fresh in your mind
• Do not hesitate to ask the health care provider to go over the bill to explain any apparent anomalies
• Work with your insurer to assure the medical procedure costs are appropriate from their perspective.

From your perspective as an Information Quality practitioner, ask yourself how this anecdote of one kind of IQ problem might apply in your organization:
• Where might your organization have broken information processes?
• In what way might those broken processes negatively affect your customers?
• What are the root causes of poor quality information in those processes?
• What can you do to improve the processes to prevent information defects that cost your organization in process failure and “information scrap and rework” and in potential harm or dissatisfaction among your customers?

What do you think? Share your thoughts on this blog to help bring in the Information Quality Revolution!!!

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