Have you ever had difficulty making any sense out of a bill — or series of bills — that you were sent for a recent hospital stay? You’re not alone. Millions of Americans find it almost impossible to decipher their medical bills, and the federal government has at long last taken some steps to help clear up some of the confusion.
In early May 2016, the Department of Health and Human Services unveiled an initiative to encourage health care companies, information technologists, and other innovators to design medical bills that are easier for patients to understand.
‘A Bill You Can Understand’
Speaking at the 7th annual Health Datapalooza conference in the nation’s capital, Health and Human Services Secretary Sylvia Burwell issued her challenge in the form of a contest entitled “A Bill You Can Understand.” The contest is a joint venture between HHS and AARP, a powerful lobby for the interests of older Americans. Administering the competition will be Mad*Pow, a design agency headquartered in Portsmouth, New Hampshire.
In a press release issued in conjunction with Secretary Burwell’s announcement of the contest, HHS noted that basic flaws in the billing process itself were responsible for much of the confusion. Patients may receive bills from multiple health care providers, hospitals, laboratories, and specialists for a single episode of care. The lack of uniformity between these bills and their use of medical jargon can make it “difficult . . . to understand what they owe, what their insurance plan covers, and whether the bills are correct or complete,” according to HHS.
Part of a Broader Effort
In announcing the contest, Secretary Burwell said that it was part of a broader HHS program to put patients “at the center of their own health care.” She said that as part of that effort, the Cabinet department hopes to create a forum that will allow all affected parties to express their views on the problem and offer potential solutions. Such a forum would encompass patients, doctors, hospitals, innovators, and insurers.
Entries in the contest will be accepted until August 10, 2016, and winning entries will be announced at the annual Health 2.0 Annual Fall Conference, which will be held in Santa Clara, California, September 25-28. Individuals or groups submitting winning entries will receive cash prizes of $5,000 each. The winning designs for medical bills will also be displayed at the Health 2.0 meeting.
6 Organizations to Vet New Bills
To put the winning designs to the test, six major health care organizations have made a commitment to test or implement the new billing formats with the customers they serve. Handling a total of more than 10 million annual patient visits, these organizations are Cambia Health Solutions, headquartered in Portland, Oregon; Geisinger Health System, based in Danville, Pennsylvania; INTEGRIS Health, Oklahoma City; The MetroHealth System, Cleveland; Providence Health & Services of Seattle; and University of Utah Health Care, Salt Lake City.
Providing patients with medical bills that are easier to understand should also help to reduce billing mistakes, which are much more widespread than most of us realize, according to a 2007 ABC News report that was aired on the network’s Good Morning America. According to the report, a group of auditors hired by health care insurers found errors in about 90 percent of the hospital bills they examined. An audit by Equifax, one of America’s big three consumer credit reporting agencies, found an average error of $1,300 in each hospital bill totaling more than $10,000.
Jargon Puzzles Consumers
What’s more, the services for which patients are billed are shrouded in medical jargon that most health care consumers are unable to decipher. As examples, Good Morning America cited such terms as “thermal therapy” for ice cubes and “mucous recovery systems” for facial tissues.
Although indecipherable hospital bills and billing errors are hardly a laughing matter to those who are being victimized, some of the absurdities involved in medical billing were pointed out in a 2015 column by Elisabeth Rosenthal, a nonpracticing medical doctor and reporter for The New York Times.
Rosenthal recounted her difficulties in getting an explanation of the individual charges listed in a medical laboratory bill totaling a relatively modest $225. Although it was not a particularly large sum, Rosenthal understandably wanted to know just what she was paying for.
Codes Difficult to Interpret
Rosenthal reported that the bill in question contained plenty of information, but it was information that she had no way of interpreting. The bill included charges for multiple test codes, such as 107, 127, and 164, as well as some five-digit CPT (Current Procedural Technology) codes, such as 87481, 87491, and 87798. Repeated attempts to speak to someone at the laboratory’s billing office had been directed to voice mail. Rosenthal had left messages, most of which were never returned.
Finally, Rosenthal did get a call back from a laboratory employee who told her that she could not disclose what the codes represented because to do so would be a violation of patient privacy. Rosenthal explained that she was the patient on whom the tests were performed. Nevertheless, the lab representative politely explained, “I’m sorry, this is what I’m told, and I don’t want to lose my job.”
Standardization Needed
In her quest to delve deeper into the mysteries of medical billing, Rosenthal spoke to Mark Hall, a professor of health care law at Wake Forest University. He confirmed much of what Rosenthal had already discovered for herself. “Medical bills and explanation of benefits are undecipherable (sic) and incomprehensible even for experts to understand, and the law is very forgiving about that,” said Hall. “We’ve not seen a lot of pressure to standardize medical billing, but there’s certainly a need.” And, as we’ve seen, it’s a need that has finally been recognized by the federal government. What changes might result from the government’s initiative remain to be seen.
In discussing some of the systemic problems that have contributed to medical bills that are all but indecipherable, HHS Secretary Burwell cited the lack of IT interoperability from one health system to another. She acknowledged that plenty of work needs to be done to create “the kind of open, connected health system that is needed for lasting system transformation.”
Establishing Common Standards
The first step in ensuring that different health IT systems can easily communicate with one another is the creation of common standards that would ensure all parties are speaking the same language, said Secretary Burwell. “Second, we need to change the culture around the access to information. Doctors and hospitals need to recognize that people have a right to access their own electronic health information. Data blocking can’t be tolerated, and a patient’s data needs to be able to move to all the clinicians that are treating that patient.”
If you’d like to read additional articles on topics of interest to health consumers, check out our blog.
We specialize in providing our over 1,000,000 customers with relevant product and condition information created by our professional editorial staff which includes our team of medical writers, medical practitioners, and health educators. eDrugStore.com Staff on Facebook