Errors in Your Health Records Can Cost You Big-Time
How to Check and Change Yours
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.
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.
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)
- Urological (urinary tract) used instead of neurological
- Below knee amputation called “baloney amputation”
- 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, 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.
Electronic medical records are poised to replace paper varieties. Though expected to reduce errors and save money, will they put patients’ privacy at risk?
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) has already begun to replace most all paper versions, and drastically improves 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 works, 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.”
Medical News Today: Primary Care Troubled by Coding Errors
Health Affairs, 24, no. 5: 1103-1117