You may remember the Schoolhouse Rock cartoon “How a bill becomes a law” from the ‘80s. More recently, Cleveland.com taught readers how a hospital bill becomes a pain in the butt. Like the hundreds of men and women in Congress, as well as the president, who play a part in reviewing a government bill, around 289 people play a part in reviewing and creating a hospital bill for each patient, according to Cleveland.com. While a government bill can be voided, hospital bills can never be avoided, even if the patient files for bankruptcy. That’s why it’s of the utmost importance that staff checks their math as they tally your charges, otherwise you’ll owe a lot more than what you were treated for.
Since the development of your bill begins during your pre-admission testing and ends a few weeks after your discharge, Cleveland.com came up with a hypothetical bill in which a patient is admitted for four days due to surgery. This bill enumerates the steps taken (presented below) and the 289 people involved throughout the process. Cleveland.com then explains what can go wrong in each step.
- Step 1: Patient and surgeon pick a hospital that is also covered by the patient’s health insurance. Patient information is also gathered.
- Step 2: Patient is checked in for surgery after registration. Everyone who deals with the patient must record their activities on paper or an electronic chart.
- Step 3: Patient stays in the hospital for four days and is attended by several dozen hospital staff members. During this time, there is constant communication between hospital employees and the patient’s insurance company regarding the medical condition of the patient and the treatment needed for a full recovery.
- Step 4: The bill is compiled by less than a dozen members of the hospital’s staff. Hundreds, or even thousands, of entries by different members of the hospital’s staff are assigned codes that are used for billing purposes.
- Step 5: The patient’s medical record is transformed into a universal bill that is submitted to the insurance company as a claim. Both the patient and the insurance company receive the bill.
A lengthy process like this tends to be a breeding ground for mistakes and errors. As Cleveland.com mentions, clerical errors as simple as the misspelling of a patient’s name can cause big problems since the insurance company can disallow any authorization for a patient’s surgery or procedure when the misspelled name can't be located in the company’s records. Extra tests administered during pre-admission testing due to lost or improper data will also drive up the cost of a patient’s medical bill, which is why a patient should choose a hospital that has well-trained health care professionals. (For more on that, read this: http://www.webmd.com/healthy-aging/guide/choosing-hospital) Of course, the patient should not be charged with all the responsibility. Since so many mistakes can happen in just the first step of the billing process, it’s important that the patient and the hospital’s staff communicate often so that no confusion or unnecessary issues occur.
The bulk of the mistakes that can happen in the billing process occur when several dozen hospital staff members come into contact with the patient. Nurse rotations and morning checkups by doctors are all common things that occur during the billing process, but unexpected issues like post-op complications can lead to necessary tests or even another surgery. Such unavoidable instances can significantly increase the charges on a patient’s medical bill.
What can be avoided, however, are the small errors that become monumental. Since nurses and lab employees come in contact with a patient more than anyone else, these errors often occur due to their negligence. Nurses usually take care of multiple patients, so there is a possibility that a patient’s medical chart could be switched with another patient’s chart. This negligence could result in improper care and wrong medications being administered to the patient. According to Cleveland.com, the charges added due to these medical errors can be astronomical, and they can cause serious issues when the insurance company reviews the bill.
After the patient is discharged from the hospital, a hospital administrative clerk then begins to collect the medical charts and records that were written during the patient’s stay. These charts are then reviewed for missing or unnecessary documents. All of the documents are then scanned as codes, which is the “universal language of medical billing” according to Clevaland.com. The insurance company receives the final version of the bill, which is submitted by the hospital as a claim, sometime after a patient’s discharge. When the insurance company reviews the bill, one of four things can happen:
- The bill is accepted as a claim and it is processed for payment;
- If the insurance company can’t find the patient in its records, the claim will be rejected outright;
- The claim could be kicked back, or delayed, because additional documentation is needed;
- Part of the claim, or even the entire claim, could be denied.
Once the insurance company and the hospital come to an agreement, a bill is sent to the patient. If the patient disputes all or part of the bill and decides not to pay, then the hospital transfers the bill to a collection agency.
Patients are encouraged to keep track of who they talk to as well as the type of coverage they have. Just as the hospital and the insurance company keep their records, it’s always a good idea to keep your own detailed records, so you’re prepared for any potential dispute about your bill.