Tuesday, May 13, 2008

SPIRIT can shred red tape


A recent report on the SPIRIT log shows that process improvement can show up in unexpected ways. Nice to see residents using it, too! We prefer that they spend time with patients rather than dealing with red tape. With an organization of our size and history, we can expect bureaucratic glitches to show up a lot.

Location of Problem: Employee Health & Emergency Department

Problem: I was recently splashed in the operating room and directed by employee health to have my labs drawn in the ED since it was 4:30pm. In the ED, my vitals were taken and my blood was drawn by an RN. The triage nurse of the ED confirmed that obviously there would be no bill sent, yet about 2 weeks later I received a bill from both the ED Department and the ED Physician for almost $600. After speaking with employee health, I was told this happens "all the time" and I can expect to receive another bill or two but they would work on getting the charges reversed - but it would not be immediate.

Suggested Solution: Better coordination between employee health and ED billing. First, the billing for an occupational exposure should not occur, but if it does, the reversal of charges should be immediate. I shouldn't have to waste my time and continue to follow up through a cycle of bills. I should be able to contact the billing department and have a zero balance as soon as the report of the error occurring.

Person Describing Problem: Vijay Saluja (Anesthesiology Resident)

Root Cause: Vijay, thank you for calling this out. I can address the BIDMC ED charging issue. You are correct that the charges should not have been billed to you for an occupational exposure. There are provisions for covering those cases. Thanks to your call out we have identified a system bug that caused the BIDMC charges to be billed to you and to others in error, and the inconvenience caused is regretted. Martina Comiskey, Revenue Cycle Systems and Training.

Solution (after investigation): Billing system configuration issue causing BIDMC charges to bill to patients instead of Workers Comp Coverage. Needs to be resolved to prevent future incidences. Retroactive report of all impacted patients needed. All accounts need to be corrected and the charges appropriately redirected.

Action Plan (who, what, by when)
WHO: Revenue Cycle Systems team

1) BIDMC billing system bug fix - completed 5/8/08
2) Retroactive reporting will be completed 5/9/08
3) All patient accounts will be corrected by 5/12/08
4) Monitor monthly to ensure that process is working as intended.

Investigation Closed (Complete w/ root cause, solution, action plan complete)

4 comments:

nasov said...

This is a great example of the SPIRIT program. That billing snafu is such a common one, and unless somebody is looking for solutions it just becomes part of the customer service script -- "just ignore those, we know you don't owe anything." That's an easy save in the instant, but added up is a lot of phone call time. I think I finally "get" what you are trying to do.

Paul Levy said...

Right! Little work-arounds every day lead to discontent, inefficiency, errors, and so on.

Anonymous said...

Not criticizing this particular situation, which is rather mundane, but - I would be curious on your thoughts, Paul, (coming from outside the industry) as to why accurate billing is such a universal problem for almost all hospitals. Everyone has a story, each one more ridiculous than the last. Is it that the computer systems are too inflexible, the front line staff doesn't bill correctly, the sheer volume of items for a hospitalization is overwhelming, the third party payment system, all of the above, or what????

Paul Levy said...

Yes.

:)