It doesn’t take much research online to find stories of millions of dollars in medical bill overcharges. And that is what we will investigate in the first part of the Problem, or 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, also medical terminology, abbreviations and poor hand writing all contribute. In short, any thing could and probably does happen.

I know I have been called by lab and radiology and even dietary asking about an order in the computer. Just the other day I was called by lab and asked if I wanted the magnesium level drawn now even though one was done earlier in the morning. Since there was no order I said no.

Literally, sometimes getting a lab value or an x-ray is a matter of life or death and in those cases a phone call, an urgent tone of voice plus a promise of an order in the near future will get the lab or x-ray done immediately.

Once the situation has passed is an order placed? That is the goal yes, but like other things sometimes it is missed.

Other save guards are in place also, for instance hospitals may require doctors to enter there own orders into the computer. This eliminates several steps and presumably would cut down errors but not always. Nurses routinely do chart checks to make sure the orders are noted and correct.

As for the supplies, I can give you an example. One night I was particulary busy tending to two ill patients. Running from task to task to make sure each had proper care. When I finally sat down I had stickers from supplies all over my top.

Of course I tried to put the appropriate sticker with the proper patient. And I think I did just that, but with a hectic work load there stickers sometimes are misplaced.

And finally I would like to relate to you a case of human error that was very well intentioned and not discovered immediately. As I have said I have worked in a variety of care settings. And this example took place in the NICU. We had the habit of placing small squares of fleece beneath the babes. This was to prevent skin breakdown and make the issolette more comfortable.

Little did we know that these fleece squares also made the x-rays appear pathcy, with more white than there otherwise would have been. So what started as a well meaning comfort measure actually was counter productive.

Billing errors are common on medical bills. And as I have described above some of these overcharges are the result human error inputing the charges. Part II however deals with a different sort of problem.

Of course in the real world things are much more complicated, but for now it is a good place to start. Later on I will give examples of what supplies Medicare will allow and what Medicare will not allow.

Back to the example, once a physician writes the order it is placed in the computer. If a lab test was ordered it will specify what kind of test and maybe even if the venipuncture is to be done by the phlebotomist or a nurse.

Likewise, if an x-ray was ordered it is entered into the computer. On the computer screen it will specify if it is to be a portable x-ray or not, and what body part is to be x-rayed.

From personal experience I can tell you that personnel from both radiology and lab will ask “is the order in the computer”? And rightly so, the radiology technician and all the lab personnel want to be paid. The order that was generated by the computer entry will be billed to the patient to pay for the service performed.

By the way, nursing services are included in the cost of the room or as part of the ED visit. Nursing services by and large are not billed separately. Nor can we take tips, although I have been offered one more than once.

Anyway, that pretty much describes billing for service, no matter if the service is a lab test, x-rays, dietary, respiratory treatments, physical therapy, or occupational therapy. Even consultations for another physician’s opinion, such as a surgeon or gastroenterologist are put into the computer.

But for supplies it is a different matter. I have seen supplies charged out using little stickers on the item that are placed onto “charge cards”. And I have seen a bar code reader that scans the item for the appropriate patient right in the supply room.

In that way the patient is billed for the item used. Also it gives the hospital some means of inventory control, how much of what item was used.

Now again this is simplistic and later on I will contradict myself when we discuss routine versus ancillary services. But for this most basic approach that is how the patient is billed.

It seems like a straight forward system. And it is, but as we continue our look at medical billing errors and overcharges you will see how this becomes incredibly complex.

When they are lying in the hospital bed, costs and the bill aren’t upper most in their minds. In fact more often than not family members have told me to do everything you can for their loved one, not even considering the cost.

It is when they get home, weeks later, when they receive the bill that the surprise comes. And while most I am sure, feel they should pay a portion of the bill, some are completely flummoxed how a 3 day hospital stay can rack up tens of thousands of dollars.

No doubt you have heard stories about out of control costs and bills being sent to collections, they are easy to find online. And I can imagine the anxiety and sleepless nights some must feel, not being able to pay there debts.

So in keeping with the tradition of patient advocacy that nurses adhere to, this blog will examine some actual hospital and medical bills. Throughout the weeks ahead you will see how those bills may be overcharged or in error of 400% or more.

There are excellent resources on the internet including 10 Ways to Avoid Outrageous Hospital Overcharges. But I intend to provide more information and examples from the bills I have audited.

Follow along as hospital bills are examined, and in one case you can decide for yourself if the hospital billing and coding department was guilty of fraud.