Common Medical Billing Mistakes – Part I

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iStock_000034851034_SmallBeing a patient in the hospital can be a scary experience; even a so-called routine procedure can raise your blood pressure. We definitely appreciate the hospital staff for taking care of our health, especially if we’re in a life or death situation. During a medical emergency, you might even say that there is no price you can put on the care you received.

But when the medical bills start arriving, you suddenly realize a price has been put on your health and the treatment you received. If you’re like the majority of people, you might be shocked to find out just how much being treated at a hospital costs you.

Hospital and doctor’s office visits are becoming more expensive. Most Americans who file for bankruptcy do so because of high debt from medical expenses. Medical billing advocacy groups have done some research into medical billing practices and have found that mistakes are often made. Unfortunately, sometimes these mistakes aren’t really mistakes at all; they’re deliberate.

There have been healthcare laws put into place to attempt to protect the American people. Despite this, though, some hospitals and doctor’s offices are finding ways to make up for price cuts. Below are just some of the common mistakes made by the medical billing community, some of which are often made on purpose:

Duplicate Billing

Duplicate billing is one of the most common mistakes made on medical bills. Most hospitals and doctor’s offices run at a very fast pace. It can be easy for someone to make a mistake. Perhaps a medication was given to a patient and both the doctor and a nurse made note of it in the patient’s chart. The billing staff then reads the chart, sees two separate entries for the medication and bills the insurance and patient twice.

Unbundling

Unbundling could be an honest mistake or it could be done deliberately. This type of medical bill overcharge occurs when a group of medical procedures should be billed as one bulk procedure, but are instead billed separately. Unbundling is a mistake that could be made by someone who isn’t very experienced in medical billing or by an experienced biller.

At times, unbundling happens deliberately. You can imagine how much higher a patient’s bill would be if they were charged for each individual component of a procedure. This is one way in which hospitals over charge in order to receive a higher payment.

Not Knowing Current Codes

Medical billing codes change frequently. Generally, coding books are released annually and show what changes have been made, including new codes. If a medical billing specialist isn’t familiar with new codes or continues using the old codes, you could receive an inaccurate bill. There are certain updates in which insurance companies no longer cover procedures under the old billing codes, but they will cover them under a new code. If a biller doesn’t know this and they use the old code, the insurance could deny the claim. This could mean a higher out of pocket cost for you.

Not Checking Insurance Coverage

At times, due to the busy atmosphere in a provider’s office or in a hospital, the medical biller may not update your insurance information. If you’ve had any change in your health insurance, give the medical billing office your new information. Without that information, any estimates given to you may be inaccurate. Your old health insurance policy might have covered a specific procedure, or a percentage of that procedure, but your new policy may not. You could think you’re covered for treatment and then get an exorbitant bill later because your new policy didn’t cover the procedure. It’s a good idea to know how much of the balance you’re going to be responsible for.

Balance billing is a practice that occurs across the country, and in some states is illegal. Check your state’s laws to see whether or not balance billing is legal. Basically, with balance billing, whatever the insurance doesn’t cover is the patient’s responsibility. So, if your health insurance company paid 60% percent of a procedure, your doctor’s office would send you a bill for the remaining balance. This may be a just practice, or it could be an illegal one, depending on your state’s laws. If your insurance company has a contract with the medical provider, you may not have to pay the remaining balance. Contracts make the hospital reduce the fees charged. The 60% paid by your insurance is a contracted fee, meaning that is all that will be paid to the doctor. Some provider’s offices try to get away with purposeful balance billing, hoping the patient won’t know that they aren’t responsible for the remaining balance.

Incorrect Claim Information

Incorrect patient information on a claim is a common billing mistake. This may be just a simple clerical error—your name was misspelled, the wrong date of birth or SSN was entered, or the biller entered the wrong sex. When this happens and a claim is sent to an insurance company, the claim will be denied due to inaccuracy. The problem needs to be fixed and the claim has to be resubmitted. In the mean time, the billing office may end up sending you a bill for the full amount even though the insurance hasn’t yet paid.

Whenever you receive a hospital bill or a statement from your doctor’s office, study the form carefully. There may be mistakes that have been made on your bill, and you can save money if you’re able to find those mistakes.

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One response to “Common Medical Billing Mistakes – Part I”

  1. Kate Branham says:

    I like how you said about unbundling, “This type of medical bill overcharge occurs when a group of medical procedures should be billed as one bulk procedure, but are instead billed separately”. I would like to think that if this ever happens it would be on accident and not on purpose. I have never had an experience where medical bills became a problem, but I can only imagine how stressful it must be.