Decoding Confusing Medical Bills
From the New York Times
October 13, 2005
Helping Patients Decode the Bill
By KATIE HAFNER
The bureaucratic tangles and mysterious lingo of the health care industry make filling out income tax forms seem simple.
Far less well-known than the nation's professional tax preparers - but every bit as helpful - is a cottage industry of private consultants who take medical paperwork off patients' hands.
Lin Osborn, one such consultant, is part of a group of medical billing advocates scattered around the country who organize bills, comb through them for errors, negotiate with collection agencies and spend hours on the phone haggling with insurance companies on a client's behalf.
"People think they can do what I do on their own, and theoretically they should be able to," said Ms. Osborn, 56, who lives in Hastings-on-Hudson, N.Y., and holds a master's degree in health advocacy. "But when problems occur, people are absolutely clueless."
Some billing advocates charge a fixed percentage - typically a third of the amount they recover - while others charge an hourly rate of $100 to $200. For people who are healthy but want someone to keep track of their bills, some billing advocates charge a flat annual fee of $450 to $500.
Like many other specialists in billing, Ms. Osborn has an encyclopedic knowledge of the codes that govern how payments are made in the health care industry. She knows when to suspect that an item on a hospital bill has been coded incorrectly and how to word correspondence to get results.
The key, she said, is knowing which questions to ask.
Ms. Osborn and other advocates rely on printed guides and references, many of which are publicly available.
One is "The Medical Bill Survival Guide," by Pat Palmer, founder of Medical Billing Advocates of America (www.billadvocates.com).
Another is "Essentials of Managed Health Care," by Peter Kongstvedt.
Ms. Osborn says she also uses the Physicians' Desk Reference and "The Red Book: Pharmacy's Fundamental Reference" (Thomson), which contains a comprehensive listing of every medication sold in the United States, along with the dosages it comes in and the average wholesale prices.
Another reference recommended by Ms. Osborn is "Medical Abbreviations: 24,000 Conveniences at the Expense of Communications and Safety" by Neil M. Davis, which explains the shorthand that physicians and hospital staff enter on medical records.
A software program called Encoder Pro, published by Ingenix, costs $900 and allows the user to cross-check billing codes. For instance, a broken foot might get miscoded as a sprain, and the software can catch the mistake.
Ms. Osborn has been in business for more than seven years, and although she is an expert in the field of medical billing, she still finds herself stumped on occasion. "There's a bunch of us who talk to each other every other day with a new problem," she said. "We exchange information all the time because not everyone has seen everything."
October 13, 2005
Helping Patients Decode the Bill
By KATIE HAFNER
The bureaucratic tangles and mysterious lingo of the health care industry make filling out income tax forms seem simple.
Far less well-known than the nation's professional tax preparers - but every bit as helpful - is a cottage industry of private consultants who take medical paperwork off patients' hands.
Lin Osborn, one such consultant, is part of a group of medical billing advocates scattered around the country who organize bills, comb through them for errors, negotiate with collection agencies and spend hours on the phone haggling with insurance companies on a client's behalf.
"People think they can do what I do on their own, and theoretically they should be able to," said Ms. Osborn, 56, who lives in Hastings-on-Hudson, N.Y., and holds a master's degree in health advocacy. "But when problems occur, people are absolutely clueless."
Some billing advocates charge a fixed percentage - typically a third of the amount they recover - while others charge an hourly rate of $100 to $200. For people who are healthy but want someone to keep track of their bills, some billing advocates charge a flat annual fee of $450 to $500.
Like many other specialists in billing, Ms. Osborn has an encyclopedic knowledge of the codes that govern how payments are made in the health care industry. She knows when to suspect that an item on a hospital bill has been coded incorrectly and how to word correspondence to get results.
The key, she said, is knowing which questions to ask.
Ms. Osborn and other advocates rely on printed guides and references, many of which are publicly available.
One is "The Medical Bill Survival Guide," by Pat Palmer, founder of Medical Billing Advocates of America (www.billadvocates.com).
Another is "Essentials of Managed Health Care," by Peter Kongstvedt.
Ms. Osborn says she also uses the Physicians' Desk Reference and "The Red Book: Pharmacy's Fundamental Reference" (Thomson), which contains a comprehensive listing of every medication sold in the United States, along with the dosages it comes in and the average wholesale prices.
Another reference recommended by Ms. Osborn is "Medical Abbreviations: 24,000 Conveniences at the Expense of Communications and Safety" by Neil M. Davis, which explains the shorthand that physicians and hospital staff enter on medical records.
A software program called Encoder Pro, published by Ingenix, costs $900 and allows the user to cross-check billing codes. For instance, a broken foot might get miscoded as a sprain, and the software can catch the mistake.
Ms. Osborn has been in business for more than seven years, and although she is an expert in the field of medical billing, she still finds herself stumped on occasion. "There's a bunch of us who talk to each other every other day with a new problem," she said. "We exchange information all the time because not everyone has seen everything."
posted by Kathie Bracy at 12:31 PM
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