HARTFORD, Conn.-Hospitals, clean up your billing practices.
That's the message Connecticut Attorney General Richard Blumenthal and the Connecticut Commission on Hospitals and Health Care sent to the state's 34 acute-care hospitals last month.
In a five-month investigation and audit of 597 hospital bills, the state found hospital bills to be confusing and hospital personnel difficult to deal with.
Publicly, hospitals welcomed the state's recommendations. Privately, they found them somewhat disingenuous.
State officials said they found errors in 31% of the bills sampled and "a pattern of indifference and insensitivity among many hospitals" to consumer billing questions and concerns.
However, the error rate was downplayed in a press release describing the state's findings and recommendations. Just 9% of the audited bills had prices that were higher than the rate and charge schedules that hospitals are required to file with the state.
The other billing discrepancies concerned lower prices, rounding differences, missing quantities and prices or items not included in hospitals' filings with the state (See chart).
The state's 51-page report, which proposed billing improvements and enforcement of civil penalties for errors on patient bills, comes just as Connecticut hospitals are plotting how to deal with a 17% revenue tax included in the state's fiscal 1996 budget.
The tax, which is expected to generate $342 million, is passed along to patients to help subsidize hospitals' charity-care expenses. But hospitals are livid about a budget-balancing gimmick to divert 23% of the proceeds into the state's own coffers.
Strangely enough, the state has been blasted by hospitals and local media organizations for attempting to eliminate explicit billing references to the 17% tax.
The state's budget legislation includes new language to require hospitals to file rates and charges with the state that include all applicable taxes in the price of each item. Hospitals said that instead of listing the tax separately, they must build it into rates for patient-care services.
Because the tax brouhaha surfaced after the billing investigation began, the report doesn't address that issue specifically.
However, the report does call for legislation to require hospitals to inform all patients of their right to get an itemized bill in a timely fashion. It also calls for patients to be notified of the state's ability to enforce civil penalties for errors on patient bills.
"The consistently repeated plea was for plain language-straight talk, clear accounts, accurate numbers-comprehensive to the average person on the street," Blumenthal said.
Deborah R. Hoyt, a spokeswoman for the Connecticut Hospital Association, said hospitals are struggling to comply with "ever-changing state and federal billing regulations."
She said the CHA welcomed scrutiny of hospitals' complex billing and collection practices as a means of educating the public. Several hospitals already have taken steps to improve billing systems and handling of patient inquiries.
Connecticut hospital billing discrepancies
Discrepancy Number Percent
No price listed on rate schedule 85 46
No quantity listed 47 26
Billed prices lower than rate schedule 29 16
Billed prices higher than rate schedule 17 9
Rounding differences 5 3
Total 183 100
Source: Connecticut attorney general's office