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A quick review is in order: all items on your hospital bill originate from a physician’s order. Supplies are charged by various methods either from stickers from the item on a “charge card” which is collected nightly to a scanner.

So why do you read and hear about stories of millions of dollars in hospital overcharges? That is what we will investigate in part I of the problem, human error.

Mistakes happen, that is part of life. And sometimes when we try the hardest we make the most. The same applies to entering orders. A wrong test is ordered, or wrong date or not in proper time sequence. It could happen and it does happen.

I know I have been called by the 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 future will get the lab or x-ray done immediately.

So is the order always placed in the computer? After the situation is more calm then we all try to catch up and put in missing pieces. But sometimes things are missed.

Other safe guards are in place also, for instance hospitals may require doctors to enter their own orders into the computer. This eliminates several steps and presumably would cut down errors. Nurses routinely do chart checks to make sure the orders are noted and correct.

And remember those stickers and supplies? I can give you a personal example, this happened a few nights ago. I had two sick patients and I was very busy running from room to room giving care. At the end of the shift I had sticker all over my uniform top from the supplies I had used.

When it was time to affix the stickers to the “charge cards” I had to remember which sticker and corresponding supply I used for which patient. I am sure I did just that, but with the acuity of patients nowadays and the hectic work load stickers can be misplaced.

Something simple intended for the comfort of the patient can also lead to errors on billing. Let me give you an example. I have worked in a variety of care setting as I have said. This takes place in a Neonatal ICU. There we would put fleece squares in the bottom of the isolette to prevent skin breakdown.

Little did we know that these fleece squares also at times made the x-rays appear patchy, with more white than there otherwise would have been. So what started as a well meaning comfort measure actually was counter productive. The reason for the patchy x-ray was quickly discovered by a bright physician and fixed.

So I hope you can see how human error can contribute to hospital and medical bill errors. I have given several examples how they may occur. The next part will deal with a different kind of error however.

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