Let’s do a quick review; most items that appear on your hospital bill first originate as a physician’s order. The computer stores the order and billing is carried out. For supplies the patient is charged by various methods including stickers transfered from the item used to the “charge card”.

It is no surprise in this day and age to read about hospital bills gone awry. Millions upon millions of dollars mistakenly included on a medical bill. That is what Part I will address, human error.

Everyone makes mistakes and that happens when entering orders as well. Perhaps the date is wrong or the test is not exactly what the physician ordered. In short, anything could and probably does happen.

Just the other day I got a phone call from lab about a magnesium level ordered on a patient. One had been drawn earlier in the morning and since there wasn’t an order I canceled it. But this goes on with radiology, pharmacy and even dietary, questioning about an order in the computer.

Safety of the patient isn’t compromised purely waiting for an order. So the service is rendered first and then an order is put in, most times the department will remind you to do so. So a stat x-ray can be completed with the promise of an order later.

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

And finally I would like to relate to you a case of human error that was very well intentioned and not discovered immediately. As I have said I have worked in a variety of care settings. And this example took place in the NICU. We had the habit of placing small squares of fleece beneath the babes. This was to prevent skin breakdown and make the isolette more comfortable.

How could we have guessed that that little square would be counter productive. You see in some cases the fleece made the x-ray appear more patchy and white than it was in actuality. The cause was found quickly for the patchy x-ray by a clever physician and was fixed immediately.

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.