Week 7 – The Customer Is Always Right

Apr 04, 2019

Hello! This week, I wanted to discuss my remaining results by starting with a story of how a broken nose led me to a medical internship at an emergency health center for two weeks.

In November, I was playing an innocent game of basketball with some friends from Fremont High when I was hit really hard in the nose. As I stood up dazed with blood gushing from my nose, I rushed to an Emergency Center (Name protected for anonymity) in Palo Alto to make sure that I didn’t have a concussion. While I waited for an X-Ray in the emergency room, I walked around and found a board of medical billing data on the wall. Considering this was my research field, I got really excited and asked a nurse if I could see any more medical billing data. She said that she had never seen anyone get so excited over medical billing data, so she offered me a short two-week internship at the Emergency Center to collect data on medical billing errors.

This internship allowed to me record data for the last two phases of my methodology – the standardized provider model and statistical tests. In this blog post, I will discuss the results of the standardized provider model.

The standardized provider model revealed that the CPT codes of doctors could be prone to error. One powerful anecdotal example was an example of the treatment of a spleen. In this anecdote, a doctor had interacted with an inflamed spleen that had a high chance to rupture. However, before its coding, the spleen had not yet ruptured, but the doctor coded for the ruptured spleen. This increased the cost for patient because the insurance rejected the claim. As a result, insurance providers could utilize this error-prone system to increase the debt of patients.

In this portion of my methodology, I found a possible mechanism for medical billing errors that can be utilized by insurance providers to increase billing costs for patients.

Next week, I’ll quantify the actual effect on patients.

One Reply to “Week 7 – The Customer Is Always Right”

  1. Krip R. says:

    Interesting find and great story! This example shows a clear effect on patients and their ability to get treatment.

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