Providers should protect patients from bogus medical debt

A lot of exciting news has come out of HIMSS in Orlando this week. And while I highly encourage you to stay up to speed on the latest and greatest in health information management via Fierce's dedicated HIMSS11 microsite, I'd like to draw your attention to another bit of healthcare news.

Here's the quote that jumped out to me in this week's Wall Street Journal Weekend Investor column: "Medical bills sent to collection in error are becoming the single greatest threat to credit scores," says Gerri Detweiler, a personal-finance expert at

As if the economy and housing market weren't dismal enough, a typical 100-point hit on a patient's credit score from a bogus medical bill could keep him or her from getting a mortgage, a car or even a new job.

The extent of the problem is shocking. According to a December study by the Commonwealth Fund, medical-billing errors damage the credit reports of roughly 14 million Americans. What's more, the Federal Reserve reports that medical bills account for more than half of all debts in collection. While the latter statistic points just as much to struggles for providers as it does for patients--as the majority represent legitimate healthcare bills--it shouldn't be patients' responsibility to snuff out mistakes.

Just how big is the problem of flawed medical bills? It depends on whom you ask. According to Stephen Parente, a professor of health finance at the University of Minnesota, about 30 percent to 40 percent of bills (including those from hospitals and other providers) contain errors. Think that's high? The Access Project, a Boston-based healthcare advocacy group, says it's closer to 80 percent. And just yesterday, TrailBlazer, the Medicare carrier covering Colorado, New Mexico, Oklahoma, Texas and Virginia, reported E/M code error rates of between 50 percent and a whopping 90 percent across a review of 200 claims.

Of course, hospitals and providers implicated in these statistics argue that their error rates couldn't possibly be that high "I've never seen convincing evidence that medical billing errors occur in the overwhelming majority of cases," Joe Fifer, vice president of hospital finance for Michigan's Spectrum Health, told the WSJ.

This reaction is entirely understandable, given how hard medical billing professionals work to get it right. Rather than getting defensive, however, providers need to do their part to investigate and rectify mistakes--whether they represent 1 percent of claims or 99 percent.

Part of the problem, ironically, may stem from the health industry's increased use of electronic medical records and billing systems, according to finance experts quoted in the WSJ. Despite these technologies' ability to reduce some types of errors, when glitches do happen, they lead to an exponentially higher volume of mistakes--as in "thousands of errors in an hour," according to a 2010 study in the Journal of the American Medical Informatics Association. This might help explain how a reasonable level of human error could explode into a 90-percent disaster.

The good news--finally--is that practices can take steps to prevent these mistakes. Some of the common problems identified by researchers included providers' failing to bill for services that were given, such as X-rays, and charging for scheduled appointments patients didn't keep. Other goofs included mischaracterizing care, duplicate charges, and, at least with the Trailblazer review, lots of broadly lumped ‘documentation errors.'

Obviously, these mistakes can be as devastating to your practice as they can be to your patients. But just in case the prospects of being audited, investigated by the OIG or missing out on earned revenue aren't enough to push you to do all that you can to self-audit your coding and billing, train staff and providers vigorously, then root out problems and immediately correct them. At least do it to protect the well-being and financial livelihood of your patients. - Deb