Medical Billing Errors – How to Spot and What to Do

Medical Billing Errors – How to Spot and What to Do

It’s the time of year where many people think about what type of insurance to get and how to get it. But insurance is not the only piece of the medical expense puzzle. Too many Americans are paying too much due to medical billing errors. Although insurance often covers these costs, sometimes they don’t. Even if they do, these charge drive up insurance premiums across the board. Many of these errors can be corrected if patients and their families know what to look for. The most common errors are below.

• Incorrect patient information: Just one letter or number can mean the difference between being charged correctly and having a claim denied or the full amount paid by the insurance company.
• Duplicate charges: This occurs when services or procedures are billed multiple times. For example, two different medical personnel state a certain medication was provided, but it is provided once and charged twice. An itemized bill should be requested and reviewed carefully.
• Incorrect quantity: Once again, check the itemized bill. Typos such as a 10 instead of a 1 are possible.
• Upcoding: Hospital charges that are coded for a treatment that is more serious, and thus more expensive, than the actual diagnosis and treatment. This practice is illegal and fraudulent. Ask the hospital to change it immediately. Common examples are administering generic drugs but charged as branded and receiving the lowest level of care at an emergency room and being charged at a higher, more expensive level.
• Unbundling of charges: When services that normally are charged under the same billing code and thus in a ‘package’ are listed separately. These mistakes can be difficult to identify unless you are a medical bill coder who thoroughly understands codes. The National Correct Coding Initiative prepared by the Centers for Medicare and Medicaid Services provides information for anyone who wants to access coding information. It can be accessed at: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/nationalcorrectcodinited/
• Duplicate billing: This occurs when a patient receives a “final bill” after their insurance company negotiates the price with the hospital or medical provider. Check the amount against the Medicare Summary provided by Medicare and the Explanation of Benefits Statement (EOB) provided by the insurance provider. If in doubt contact the insurance company and/or the medical provider.

By just checking for the most common errors on medical bills, hundreds, even thousands of dollars can be saved.