Mississippi journalist’s reporting leads medical center to change billing practices

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

In April, Anna Wolfe, who covers health care for the Mississippi Clarion Ledger, started reporting on what appeared to be staggeringly high bills for using the emergency room at the Batson Children’s Hospital, in Jackson. The hospital is part of the University of Mississippi Medical Center, the only academic medical center in the state.

Parents who brought their children to the ER were being charged thousands of dollars in unreasonable emergency room facility fees that do not match the level of care received, Wolfe reports. Since that article was published April 15, Wolfe has continued to cover the complex ways the hospital calculates its charges. In the bills Wolfe reviewed, the hospital adds facility fees for ER visits, fees that are based on the level of care administered.

In a new How I Did It, Wolfe explains that the hospital changed its billing policies in May after a combination of complaints from patients and her reporting for the Clarion-Ledger about how the hospital calculates its medical bills.

Even after making these changes, however, Wolfe says the revised scoring methodology makes it impossible for anyone visiting the ER to receive a facility fee under “level 3,” which is more than $2,000.

One patient in Wolfe’s stories was charged over $4,500 for what amounted to a check-up. “She had five minutes of time face-to-face with a physician and no new treatment,” Wolfe writes.

In addition to writing about billing issues at the Batson Children’s Hospital, Wolfe puts the topic of facility fees into context, explaining that hospitals nationwide are charging patients for level 4 and 5 visits more and more often, creating suspicions of upcoding. Upcoding is illegal and happens when a hospital, physician or other provider bills an insurance company or Medicare or Medicaid or other payer using a code for a more expensive service than the provider delivered.

For journalists covering ER billing, facility fees and upcoding, hospitals have no guidelines to determine which “level” to bill for, she writes. “Reporters should look at whether hospitals are increasingly billing for more severe visits, even if the medical problems in question don’t warrant such designations,” she suggests.

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