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How the Bronx-Lebabon Billing Statement Errors Were Preventable

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What Does Quality Mean For Hospital Billing Statements?

My wife called me at work this morning a bit frantic. She had just seen a news report about a billing error at the Bronx-Lebanon Hospital Center and wanted to make sure Creative Digital Imaging wasn’t the statement printer. We weren’t, but as I dug into the story further, I was struck by how it could have been simply prevented.

How is this Improved Patient Communications?

Like many hospitals today, Bronx-Lebanon outsources its medical billing service. The billing company used a third party subcontractor to handle the preparation, printing and mailing of the statements.

The billing service company called this a “simple mistake”; the printer had put the invoice number in the “amount due” field. The resulting bills, many seemingly in the multi-millions of dollars, caused significant stress to many of the recipients and the resulting snafu ended-up splashed across newspapers and television networks coast-to-coast.

But the real question is this; was it really a simple mistake? The unfortunate answer is, Yes and No.

The Best Medical Billing Software Cannot Eliminate Human Error

Even with the power of today’s desktop computers and software packages, mistakes happen. To err is human, and all that. But manufacturing businesses have known for decades that these errors were not just fixable, but preventable with the simple application of good documented quality control procedures.

Below, we’ve compiled four steps to creating and delivering highly accurate variable data projects. These aren’t everything you can, or should do, but it is a good start to establishing data quality best practices for the best quality printing.

First Steps to Creating Your Data Quality Requirements

1. Create a sample data file with entries that exercise each and every business logic rule including: multiple page records, account suppressions, and failure points. Set this aside and keep it updated as new rules or changes to the data file format are implemented. This file can then be used to test and certify the parsing program’s operation.
2. Create a visual map for each document linking each piece of variable data with the field location in the data file. For example, track: AMOUNT DUE from its location in the data to the physical location on the printed sheet. After each change you can then use this map, along with the sample data file described above, to verify the program’s proper operation.
3. Printed Samples: After internal review has indicated the changes are good, printed samples should be prepared and sent to the customer for review and acceptance. These samples should be produced in the same fashion as a live run, don’t print them on a side machine or networked printer. The whole intent is to test and validate the production process and you can’t do that if you’re approximating any of the steps.
4. Job Sheet Instructions: Once live, each printed job should include a job sheet with detailed instructions on the stock, inserts, and envelopes. Ideally, this would also include a visual sample of the stock layout and a list of specific items to QA. Samples of the job should be compared to this list by someone other than the operator parsing the job or the printer printing it, and should be archived in paper form for at least 90-days.

If we can learn one thing from the issue at Bronx-Lebanon, it should be this; while the error was a “small mistake” on the part of the printer, the costs to the hospital included; bad press, lost time, and hard dollars. While that may never be truly measured, much less recouped.

A handful of simple checks and balances, a little data tracking, and some small nudges to the review process could have prevented the entire incident.

That’s the real take-away. Not how simple the mistake was, but that it was a preventable printing error.

Would you like to know more about data quality measures for variable data printing? We will be presenting a session at this year’s National Postal Forum (www.npf.org) entitled “Introducing Performance Metrics to the Print & Mail Room” that will address this very topic.