Medical Billing Errors – How to Spot & What to Do

Medical Billing Errors – How to Spot & What to Do

The error rate in medical bills is a staggering 80 %.  Errors happen at all levels, doctors’ offices and medical facilities alike.  They are often from simple human mistakes. But the end result is hundreds or thousands of dollars over what should be paid by a patient.  Although insurance often covers these costs, sometimes they don’t.  Even if they do, these charges drive up insurance premiums across the board.  Everyone needs to closely examine every medical bill they receive.

 

We live in a world of technology.  Electronic records and barcoding are the norm, but can lead to errors as humans are “at the wheel.”  Patient records are created and maintained electronically.  The input operator can hold a key down too long that adds numbers to the item ordered.  Some items have a “package” price but may be entered individually by one or multiple people.  Barcodes can be an issue as well.  As we know from our supermarket experiences, scanners can read a barcode next to the correct one and/or they can be scanned more than once.  The wrong barcode can be entered resulting in over-charging or worse.  Emergency rooms can be hectic; different conditions are triaged based on severity of symptoms or injury.  A patient with a minor condition or injury may be assigned to a higher level bed due to space which may result in greater charges.   Too little is checked by the over-worked staff.

You can take charge.  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.