Common Medical Billing Mistakes – Part II

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iStock_000016604045_SmallMistakes are common—no one is perfect. But just because a mistake is made by someone else doesn’t mean that you have to suffer the consequences. This is especially true in the case of medical billing mistakes.

More and more people are suffering because of these billing mistakes and sometimes it’s even costing them their life savings. You don’t have to be a victim. If you know what to watch for, you can catch mistakes and get matters cleared up before you spend money you do not owe.

Upcoding Charges

Upcoding is an illegal practice. It is used to inflate a patient’s medical bill. A patient will be prescribed a medication or have a certain procedure done and be charged for something different. For example, if a generic medication was prescribed, the patient or insurance may be billed for the name brand drug. Or, a patient may go into their doctor’s office for a routine visit but be billed for something more severe.

Mismatched Codes

Mismatched codes go hand in hand with upcoding. If a medical biller upcodes your diagnosis code but leaves your treatment code alone (as it is shown in your chart), or vice versa, the claim will be denied. The insurance company will deny the claim based on mismatched codes. If this isn’t caught, not only will you be billed for the denied procedures, you’ll also be paying the inflated upcoding costs as well.

Being Charged For Services You Didnt Receive (Cancelled Appointment but Still Billed)

A patient might be scheduled for a procedure but have to cancel an appointment. Somehow, the medical biller will end up billing the insurance or the patient for the appointment anyway. If you rarely go to the doctor and receive an unexpected bill, you can likely catch the mistake. However, if you’re dealing with a chronic medical issue and go to the doctor quite regularly, the medical bills might be coming in often. If you’re like a lot of people in this situation, you may just pay the bill and not pay attention to treatment dates. This can cost you extra money, and insurance companies have limits on how much they will pay for certain procedures.

For instance, if you’ve been billed for six treatment visits but you’ve only received four, and the insurance company has a limit of six treatments they will pay for, you will have to pay for any additional treatments out of your pocket, unless you catch the error.

Incorrect Amounts (Number of X-Rays, etc.)

Entering the incorrect amounts on a claim is another common medical billing mistake. This could be a simple clerical error. Sometimes handwritten patient notes aren’t always clear–a 3 can look like an 8. And if a medical office uses a paperless charting system, they may accidentally hit a wrong key and enter an incorrect amount. Whatever the case may be, you’ll end up being charged for more than you received.

Billing for Longer Operating Room Times

Hospitals bill for operating room times by the minute. Most patients don’t know exactly how long they were in the operating room. Hospitals often bill for more time than was actually spent in the operating room. If you’re unsure how long you were in the O.R., check with a friend or family member who was in the waiting room during your surgery.

Not Understanding the Difference Between a Denied and Rejected Claim

At first glance, a denied claim and a rejected one seem like they would mean the same thing, but they don’t. A medical claim that has been denied might need to be corrected. Perhaps there was information missing or inaccurate patient information. The claim can be corrected and resubmitted. A claim that has been rejected is usually because a certain procedure is not covered under an insurance policy.

In either case, if you don’t know the difference between the two, you might pay money for something that should have been covered by your health insurance. The medical billing company might send you a bill for a denied claim instead of resubmitting the claim with the corrected information. Or, they could send you a bill for a rejected claim without checking to see if, according to their contract with the insurance company, you can rightfully be billed.

Many people don’t question a denial or rejection from the health insurance company. They may think the billing office is the expert and there is nothing more that can be done. However, many Americans are tenacious in checking with their health insurance company about denied or rejected claims. These individuals are being proactive in protecting their financial well-being by staying on top of the health insurance provider’s responsibilities and making sure they are not a victim of common medical billing mistakes.


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

  1. Michael says:

    Almost 30% revenue loss results from billing errors. These errors are the common cause for claim rejections by insurance companies, aka payers in the US. Medical billing is much beyond just documentation; it is the very means of revenue generation. To know more