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.

No one is perfect, mistakes are gonna happen. That is true for order entry as well. Maybe a test was ordered that isn’t quite what the physician wanted, maybe the wrong date, maybe this or maybe that. But the fact remains it could happen and frequently does.

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.

I have been in situations where a lab or x-ray was needed immediately. In those cases the department will render the service and will ask you to put in the order later. Even a reminder if it is forgotten. Patient safety is not at risk just because an order is not in the computer.

Once the situation has passed is an order placed? That is the goal yes, but like other things sometimes it is missed.

In all hospitals I have worked at nurses are required to do chart checks, be it twelve hour or twenty four hour or both, to make sure orders are properly entered and completed. This is helpful when physicians enter orders as they do in some facilities, hopefully reducing errors.

And supplies are another story altogether. This happened to me recently, I was caring for two sick patients. I was busy running from room to room giving the proper care. When I did sit down my uniform top was covered with stickers from the supplies I had used.

So to make things right I had to put the proper sticker on the proper “charge card”. I think I did just that, but with the hectic work load stickers maybe misplaced.

Even well intentioned actions intended for comfort of the patients can lead to unforeseen consequences. As I have said I have worked in a variety of care setting. This example took place in the Neonatal ICU. There we routinely put small fleece squares in the bottom of the isolette to prevent skin breakdown.

It just so happened that the fleece square affected the x-rays on some of the babes. In some cases the x-ray appeared more patchy, it had more white space. So unintentionally this comfort measure was actually counter productive. A clever physician figured out the cause and it was quickly remedied.

Billing errors are common on hospital and medical bills. And as I have described above some of these overcharges are the result human error inputing the charges. Part II however deals with a different sort of problem.