TRIBBLE: It's because of the number of people involved in a bill. As Steve Glass, the CFO at The Cleveland Clinic said, you can go in and see just two people and may not realize there are 15 people behind there and taking part in the care you're getting.
MOLPUS: And the example you use in the story of someone going to a hospital for a surgical procedure and being there a few days and as many as 289 people could have their hands in the actual billing.
TRIBBLE: Yes, 289.
MOLPUS: Who are these people? What do they do?
TRIBBLE: What they do is provide care or they are in the background putting together the clerical and administrative processes that provide care. The biggest number in that are the clinicians, the doctors and nurses who have to take notes and document what they're doing and those notes then get translated, eventually, into the bill.
MOLPUS: I saw some interesting names in addition to doctors, technicians and nurses; people ike a clinical documentation specialist, coders, and scrubbers.
TRIBBLE: Yea, the scrubbers are a computer system but the clinical documentation specialist, that's my favorite one out of all these. I talked to Southwest General (hospital) about this. A couple of years ago they started hiring documentation specialists who are registered nurses. They walk around checking the carts to make sure the clinicians are filling them out correctly. And because they have a medical background, they can not only make sure that the charts are being filled out (correctly), they can also check and make sure the care is being provided well too. It's like a second set of eyes. But it's also a set of eyes to make sure everything is written down so that it can then be translated into a code that goes onto the bill.
MOLPUS: There's the issue of human error, entering in the wrong data, but there's also an element of interpretation. Does this go with this code or that code? And there are...many codes. That's a problem?
TRIBBLE: I was just interviewing a national coding consultant with a follow-up question and she had this great comment. She said, "you know this is not just a matter of looking at a diagnosis and saying this code goes with it." You really have to "analyze the entirety of the care." That's why the documentation is so important. They can't just say "urinalysis test," they have to make sure that there's proof that the doctor thinks that a urinalysis test was needed before they can code for it. So, it's kind of an art form.
MOLPUS: So, how often do things go wrong in terms of a bill? What's the error rate?
TRIBBLE: A very good question. A lot of consumer advocates will say it’s a very high number, eight out of ten; and you talk to anybody on the street and they can tell you a medical (billing) error story; whether it’s an error or not, it's a mistake in their mind. But if you talk to people who've done research, they say up to 40% of bills could have errors, some simple errors. Up to 15% could have intentional errors.
MOLPUS: What's a consumer to do? How do we help reduce the number of errors?
TRIBBLE: Well, if you haven't picked up The Sunday Plain Dealer, try to do that. We have a special section and it says what to do. If you're in the hospital, take notes; keep your own record if you can or have a family member do it so you can compare your notes with what's being billed. Always get line-item bills. The bottom line is we're going to have to be purchasing health care like it's purchasing a car or your favorite stereo equipment. You need to do research. Call around, first. Call your insurance company and make sure it will provide coverage for...the doctor, the facility and any extras like the anesthesiologist that could be out-of-network. You gotta do your research and afterwards you've got to review your bill line item by line item.
MOLPUS: Seems like more work than many of us want to do or have done in the past?
TRIBBLE: Yes, it is.
MOLPUS: So, where's the PD taking this series next?
TRIBBLE: You know the readers have been leading this. We have heard from a lot of folks filling out our survey and telling us what the problems are out there. One of the most interesting things is when you go to what you believe is an outpatient facility and you're getting charged as if it's in the hospital. On top of that you might have a "facility fee" charge. That's an interesting case. We want to look at those. We also have been talking to a lot of the patients about the confusion of the bills too. Those are the directions we're heading.