Understanding hospital bill - "sterile supply"?

[mhendo]

@MsRobyn

Hospitals don’t use CPT codes…

You might be right. It’s not my area of specialization.

But the article i linked earlier specifically said that CPT codes could be requested as part of an itemized hospital bill.

Sloppy journalism? Different procedures in different states? I don’t know.

[MsRobyn]

@robert_andrews

Reading about hospital errors makes me wonder - why aren’t audit controls catching this stuff? I would think that if people are being given 2 pills and charged for 4, some accountant is going to raise an eyebrow when attempting to reconcile records when they see that the pharmacy was at 1000 percodan pills on 1/1/2010, received a shipment of 500 on 1/5/2010, and a total of 200 were billed during the month of Jan, according to billing records, but the pharmacy reports that there were 1400 percodan pills during end of the month inventory, leaving 100 surplus pills in the pharmacy. I would think they would have these controls in case of the opposite situation, if doctors were administering stuff and “forgetting” to bill it.

Do departments just not communicate?

Most departments generally do communicate with each other, and hospitals use a central billing office. (BTW, a pharmacy’s narcotics counts are for the pharmacy’s compliance with various regulations and reporting requirements, not for billing purposes.)

However, some supplies and drugs come pre-packaged. For example, there may be ten sterile widgets in a package, but the surgeon only uses five or six. The rest of the widgets in the package can’t be restocked, so the patient is billed for all ten. Or a drug comes in a larger vial than what is actually needed, so the patient is billed for the entire vial.

[Lynn_Bodoni]

Consider that there is a nurse assigned to count all the items going into the delivery room–not just say, “Oh, the standard tray” but to actually make sure the items are there. And then count the items coming out and make sure they’re all there again, used or otherwise. It wouldn’t be applicable for laparascopy (I don’t think) but one reason this is done is to assure that none of the implements have been left somewhere they shouldn’t, like inside the patient.

This was my grandmother’s job, way back when. Or rather, it was one of her jobs. And it IS vitally important to make sure that the patient doesn’t have any instruments or anything else left inside him/her, unless it’s something that’s supposed to be inside.

[Mama_Zappa]

@tygre

Former hospital collections worker here (and my Og, if that wasn’t a soul-sucking job…) – it’s for things like instruments, bandages, etc etc. 5K IS really high though – I agree with Lynn that you should call billing. My estimates from my work were that maybe 1% of bills had an error on them – and nearly always in the hospital’s favor, so call and get that straightened out.

*I saw a couple infant circumsicions billed to the mother or to a female baby – those were always pause for “durr, what?”. The most common errors were extra meds (billing for 4 pills when 2 were used).

Oh hell - the hospital fraudulently billed for AN ENTIRE EXTRA DAY when my son was born. I called insurance and they said “can’t do anything, hospital billed so we gotta pay”. I called the hospital and strangely, they backed it off and refunded to the insurer.

I just had gallbladder surgery a few months ago and no single line item was 5,000 for sure! The hospital-only portion was 9200 (that was the rack rate, not the in-network rate which was something like 6200 bucks).

The total for everything (including my bills for the ultrasound to confirm the diagnosis, the surgeon, the hospital, the anesthesiologist) added up to about 18,000 before the insurance discounts; about 9,000 total.

[Tom_Tildrum]

@jdc

Don’t forget that your insurance company might be paying a flat amount for the procedure based on a contract with the hospital and the bill is not really meaningful.

Bingo. Very few people actually directly pay the reported charges. There are some incentives to make the rack-rate charges very high, because there are other government and insurance payments that may be tuned to x% of reported charges, so they have an indirect influence on the bottom line.

[Shmendrik]

@jdc

Don’t forget that your insurance company might be paying a flat amount for the procedure based on a contract with the hospital and the bill is not really meaningful.

Oddly, there are frequent threads about exorbitant medical bills on GQ where this goes unmentioned. The amount on the bill from the hospital is often many times more than what the insurance company pays. Case in point: I got a bill for some lab work for $250. A bit later, my insurance company sent me a statement showing that they had paid the hospital $30 and I didn’t owe anything.