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Pat Palmer analyzes medical bills from all over the country and prides herself on her ability to crack codes.

Medical bills, typically composed of complex multi-page lists of codes, could seem confusing and intimidating to a consumer. Many hospitals, however, are making bills more patient-friendly and less burdensome to interpret.

Palmer makes a living as a medical bill reviewer. One particular code she cracked was for a cost-support device. Palmer discovered that a cost-support device translated into a teddy bear in Virginia - or a heart-shaped pillow in California.

As the founder of the Medical Billing Advocates of America, Palmer serves as a consultant for insurance companies and individuals to uncover medical billing errors. Since the association was established in 1994, Palmer has seen an increased number of corporations contracting medical bill reviewers.

More and more companies are starting to look into the large amount of money going out in medical expenses, said Palmer. They make sure the providers are paying correctly and aren't billing for things they shouldn't.

The Medical Billing Advocates of America, headquartered in Salem, Va., has 30 members in 18 states and Washington. The group is pressing for national reform to standardize medical bills and make certain charges fraudulent and abusive.

Under current law, hospitals can be prosecuted if they don't report Medicare billing errors to the federal government. The statute in the Social Security Act has a 10-year statute of limitations and includes penalties for billing for services not provided and upcoding. The law, however, only applies to misuse of federal money, and does not include provisions for individuals or companies.

Under the government, these charges are considered fraudulent and abusive, said Palmer. Why does that not stand for everyone, not just Medicare?

In Maryland, the Health Cost Services Review Commission regulates approved charges. The items must be used for a patient's care, with the exception of billing for patient convenience charges such as use of a television or telephone.

I'm not familiar with anything like that [the teddy bear], said Tony Morris, assistant vice president of financial operations for Greater Baltimore Medical Center. But disposable supplies could be part of a patient's care treatment and on the bill.

Detecting errors

GBMC has been making progress in detecting medical errors before they occur and performing self audits to target weaknesses in the billing system.

We have a compliance program that takes a more proactive approach, said Stacey McGreevy, compliance officer with GBMC. We identify errors that can occur, train people and respond quicker to other potential errors that are out there.

Two years ago, GBMC received approximately $60,000 per month in denials from insurance companies which found charges for tests that were not medically necessary. The hospital has since dropped that amount to $16,000 per month.

It was a hot area - hospitals billing for things that weren't medically necessary - such as seeing a gynecologist and him ordering a cholesterol test, said McGreevy.

The hospital now recovers approximately 85 percent of all charges because of the systems in place to prevent errors.

Morris said many of the hospital's errors are the result of human mistakes and include incorrect room charges, keystroke errors and charges for services that were never performed.

Occasionally we will see complaints for services never rendered, said Morris. Sometimes the description is confusing and the charge was correct.

Lack of training and education typically leads to errors, according to Morris.

Hospitals need to continue training, said Morris. When they put people in positions, they need to have a series of quality checks to make sure they're doing their job.

The Maryland Hospital Association also is increasing its awareness of billing errors.

We're seeing progress, said Nancy Fiedler, spokeswoman for MHA. There's an acknowledgment that because bills are complex, errors do occur.

Use it, pay for it

Palmer said patients from across the country have been billed for many ridiculous items, including gloves, sheets, drapes, gowns, flowers, towels, soap and cotton swabs. One client was billed for a fog reduction device that was nothing more than a towel to wipe the lens on a scope.

There is no explanation of what we're being charged for, said Palmer Patients assume they're important items used for their care.

GBMC said that if an item is used for the care of the patient, they will be billed for it-including cotton swabs.

If there is an error, the patient needs to go to the hospital, said Morris. If we have charged something [inappropriately], we'll take it off.

Many medical bill reviewers charge patients based on the amount of money saved. Some larger companies are charged a flat fee or on an hourly basis.

Accu-Rate, an El Paso based medical bill review company, estimates that more than 90 percent of all hospital and doctors' bills have errors and 70 percent of those errors are overcharges.

# posted by Medical Information : 3:53 AM