Errors in Your Health Records Can Cost You Big-Time: How to Check and Change Yours
by www.SixWise.com
Every time you visit a doctor's office or hospital, a record
is kept detailing everything from your weight at the time
of the visit to the diagnosis. Depending on how often you
see a doctor, your health records can become very lengthy
and complex.
While it may not occur to you to check on what's been written
in your medical records, it should. Your health and life insurance
premiums, and whether you're denied or granted coverage, are
all at stake, as insurers turn to health records as a major
source in how to price your policy.
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Your doctor shouldn't be the only one who knows what's
in your health records; it's up to you to check them
for accuracy.
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Coding System Leaves Much Room for Error
In the United States, a series of codes known as E&M
(evaluation and management) codes are used to record diagnoses
and treatments. The coding system, however, is extremely complex
and hard to use, even for professionals, and many grey areas
exist.
"I've certainly heard plenty from that particular community
about how difficult it is to get it right," said Leslie
Norwalk, Centers for Medicare & Medicaid Services deputy
administrator and chief operating officer, referring to Medicare
carriers.
In one study cited by the American College of Physicians,
the Health and Human Services Office of Inspector General
asked eight Medicare carriers to code five hypothetical patient
visits. Every one of the eight carriers coded the visits in
a different way.
Record Keeping Sent Abroad?
To add to the confusion, in the UK certain hospitals -- in
an effort to save money -- have been sending medical notes
to India, South Africa and the Philippines to have them typed
up.
The potential for error is high enough when notes are typed
up by medical secretaries in hospital, who can check with
a doctor if they can't understand a note. Abroad, there is
no one to check with plus the added variable of language barriers.
The most common errors included:
-
Trouble distinguishing between hypertension (high blood
pressure) and hypotension (low blood pressure)
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Urological (urinary tract) used instead of neurological
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Below knee amputation called "baloney amputation"
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Mix-ups with numbers such as 15 and 50
"Lives are being put at risk by hospitals desperate
to save money. Patients' medical records must be absolutely
up-to-date and accurate. The consequences of typing errors
are too frightening to contemplate. The government has to
rethink this latest idea that medical typing can be done at
a distance without risking patient health. It is ridiculous
and is a step too far," said Unison, a union for nurses
and non-clinical staff, general secretary Dave Prentis.
Tiny Errors Add up to Thousands
Tiny errors in medical coding, or the simple misreading of
a diagnosis, can add up to thousands of extra dollars to you
for insurance premiums. For instance, according to "Pick
Out Costly Errors in Your Health Records" in Money Magazine's
July 2006 issue, the code for a benign cyst is 685.
With just one minor typo, that diagnosis can easily become
chronic kidney failure (code 585). In dollars, this error
could cost you $48,100 more for a $500,000 term policy.
Inaccuracies in your medical records can even make you seem
like such a risky customer that insurers will simply deny
you any coverage.
How to Get Your Medical Records
Checking your medical records for accuracy is not as simple
as checking
your credit report. While you can visit one Web site and
have your entire credit report sent to you, you will need
to contact your doctors' offices, hospitals and pharmacies
individually to request your records. There may be a charge
for assembling the records, and you will likely have to sign
release forms first, but you do have a right to request and
receive them.
Those who have individual insurance should also request a
report from the Medical
Information Bureau (MIB), which is a non-profit group
that works on behalf of insurers collecting information from
previous insurance denials or coverage decisions.
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Electronic medical records are poised to replace paper
varieties. Though expected to reduce errors and save
money, will they put patients' privacy at risk?
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What to Look For
Once you've compiled your health records, there are several
things you should automatically check for, according to Money
Magazine.
Diagnoses: Make sure all the diagnoses are accurate and refer
to something that you've actually had. Then, make sure they
are not exaggerated. For instance, if you told your doctor
you were tired at your appointment, he or she may have listed
fatigue in your health records. This is not nearly as interesting
to insurers as a mention of the more serious chronic fatigue
syndrome, so be sure the description is correct.
Updates: You should also check for conditions that have improved
(heartburn, cholesterol, obesity, etc) or circumstances that
have changed, such as quitting smoking, and have your file
updated.
How to Correct Errors
If you do find errors in your medical records, the first
step is to send a certified letter, with return receipt requested,
to each doctor's practice that has the health records you
need to correct. Include an explanation of the error and any
proof you have to the contrary.
Another option, particularly if your health records are complex,
is to hire a claims-assistance professional, who can search
for errors for you using their highly trained eye.
Once the errors are corrected, it's up to you to bring them
to the attention of your insurance agent and ask for a better
rate.
The Next Generation of Medical Records
The buzz around the health care world is that electronic
medical records (EMR) will soon replace most all paper versions,
and will drastically improve efficiency while reducing errors.
One report published in Health Affairs even found that "effective
EMR implementation and networking could eventually save more
than $81 billion annually -- by improving health care efficiency
and safety."
Though still in the planning stages, there is growing concern
that electronic records could put patients' personal information
at risk.
"How well privacy can be safeguarded in a national electronic
system is the $64,000 question," said Carole Klove, chief
compliance and privacy officer for UCLA Medical Sciences.
She pointed out that electronic records have their plus-side,
such as allowing patients in New Orleans to fill prescriptions
during Hurricane Katrina, " … but certainly there
are risks in having all your records electronic," she
says. "Risks can result in inappropriate access."
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Terrifying Ordeal
Sources
BBC
News June 22, 2006
Money Magazine, July 2006, p. 45
The
Dallas Morning News June 27, 2006
Medical
News Today: Primary Care Troubled by Coding Errors
Health
Affairs, 24, no. 5 (2005): 1103-1117