Complex systems and software in medical insurance companies

One of my favourite American institutions is National Public Radio (NPR). Whenever I went in a new city, the first thing I would do is find the local NPR station. I still really enjoy NPR but I don’t listen as often as I use to. About a year ago, NPR ran this story about complexity in medical billing companies. How hard can medical billing be?

Because the codes, the codes that we use, did allow you to specify. Now there’s another set of codes. The old codes are called J-codes and the new codes are called NDC-codes, and the NDC-codes do have somewhere in their digits the identity of the drug maker. So the memo goes out to a million fax machines and it says ‘We now want you to use NDC-codes’ … but there’s a problem. They systems cannot fit the new codes because there aren’t enough digits.

The interview gets surreal at this point, and I don’t want to spoil the article for you … it’s well worth listening to in its entirety.

Oh, and before you dismiss this as only something peculiar to the American health insurance business, I’ve seen similar complexities in non-medical insurance and banking.

Comments are closed.