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Every morning at six, a mail truck arrives outside an office in Watertown, Massachusetts. The truck is filled with other people's hassles: box after box of medical bills. But one person's hassle is another person's business.

David Kestenbaum with our Planet Money team visited one man helping doctors deal with the one thing they hate most: paperwork.

DAVID KESTENBAUM: This professional paperwork handler, you may not know him but you know his cousin and uncle. They were both presidents of the United States.

Mr. JONATHAN BUSH (CEO, Athenahealth): My name is Jonathan Bush and I'm the CEO of Athenahealth.

KESTENBAUM: Jonathan Bush's desk does not have a chair. He likes to stand and talk. Before he was handling other people's hassles, he was handling other people's miracles. Athena actually began as a child birthing center.

Mr. BUSH: The first summer we did it, said, it's going to be the summer of wow. Every pregnant mom is going to come into this place and say, wow. Corny, but we were really excited. We really thought we had it. We literally - you could hear babies' first cries through the HVAC ducts in my little office.

KESTENBAUM: But that is when he discovered what doctors and hospitals discover: getting paid is an enormous pain in the butt. The patient is covered by Blue Cross, which Blue Cross plan? Did she need a referral? What form do you fill out to get paid? What's the right billing code?

Mr. BUSH: It became our obsession all day long. We thought nothing about women's health. We thought nothing about birth. We spent all our time screwing around with trying to get checks.

KESTENBAUM: According to one study, the over-complexity of billing is costing our country $7 billion a year.

(Soundbite of machinery)

KESTENBAUM: This the processing center where all that doctors' mail arrives. How much mail? Athena can tell you, by the pound. This is Glen Conway.

Mr. GLEN CONWAY (Mailroom, Athenahealth): When we receive the mail, you see John here. He's weighing it on that scale over there. And the reason why he's weighing it is because we've done this long enough that we know how many sort of checks per pound of mail we're going to get. And...

KESTENBAUM: You know how many checks per pound?

Mr. CONWAY: Yes. So we would get about 26 checks per pound of mail.

(Soundbite of machinery)

KESTENBAUM: The envelopes get opened by machine. Some have handwritten checks from patients. But a lot of checks come from insurance companies, which is kind of amazing if you think about it. These checks were printed out by a computer, sent through the mail, here they're opened, rescanned into a computer, checked by hand here and by workers in India, and finally electronically deposited to a bank. Who knows, the money might have started out in the very same bank's computer.

Mr. CONWAY: We'll probably do over a billion this year and...

KESTENBAUM: A billion dollars in paper checks.

Mr. CONWAY: Paper checks, correct.

KESTENBAUM: The good news: Today about 70 percent of the money comes in electronically.

Jonathan Bush says some insurance companies have been easy to work with and some have not.

Mr. BUSH: We rank all the payers. We have this pain-in-the-butt index and it ranks how big a pain in the butt all the different insurance companies are to deal with across six metrics. Cause it's such a pain in the butt to deal with insurance companies.

KESTENBAUM: Toward the bottom of that list: Medicaid of New York State. New York Medicaid requires claims be filed on paper.

Mr. BUSH: And they require you to order the individual blank pieces of paper upon which you will print these claims from Albany, one at a time.

KESTENBAUM: The form has to be signed by hand by the actual doctor - so, more mail, more paperwork.

Now, the explanation New York Medicaid has offered for this cumbersome system is that it helps prevent fraud. New York Medicaid declined to be interviewed for this story but offered a statement saying, quote, "We believe that many of the difficulties that Athena has experienced in the past were the result of a lack of understanding of New York State Medicaid billing procedures."

Jonathan Bush says he understands why some of this is still such a pain in the butt. Our health care system, love it or hate it, it just is complicated - lots of insurance companies offering lots of different plans.

Mr. BUSH: Each one of them has created some customizations that have turned into memos or faxes that have gone out to everyone. So you now have everyone has sent everyone a whole smorgasbord of little tidbits to know and keep in mind when treating this type of patient or that type of patient. Because what health-care really is, is this awkward word slapped on top of a million little tiny markets.

KESTENBAUM: That means even if the paper part goes away, the rules that govern what gets covered, how much, under what conditions, those aren't likely to get much simpler. And Jonathan Bush thinks his company is going to be around for a long, long time.

David Kestenbaum, NPR News.

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