When credit card statements arrive in the mail, people generally have no problem reviewing each and every line item to be sure the charges are accurate. If there are any instances of identity theft or double billing, they want to know so they can address it immediately before paying out their hard-earned money in error. The same goes with just about any type of bill.
Consumers want to research before they pay. Until recently, medical bills were the exception. But why, in one of the most expensive areas of a person’s finances, would someone choose to pay a bill without having it thoroughly examined?
In the past, medical bills weren’t given such attention partially because they are hard to decipher with their complex coding and partly because they can be endless and overwhelming. Plus, the U.S. population held a general attitude of not only expecting, but also accepting, that medical bills are just going to be outrageous. Because of this dismissive approach, millions of dollars have been unnecessarily paid to doctors and hospitals.
Although the United States is known for having the most expensive healthcare system in the world, quality of care, access to healthcare, and efficiency of care received are repeatedly ranked lower than other comparable countries. Having a socialized medical system is a glaring difference between the U.S. healthcare system and that of many other first-world nations.
So while it seems we are floundering through this expensive system of lesser quality, the last thing we need is the burden of trying to figure out how to pay for the hospital’s billing mistakes. Thankfully, a rise in medical bill auditing is taking root and helping many people avoid overpaying on their medical bills.
The Process
On most medical bills, thousands of dollars can potentially be disputed. Experts estimate that at least 80% of all medical bills contain errors. The American Medical Association said that in 2010, $43 billion in excess was unnecessarily paid out from commercial insurers alone, and a simple review could have helped avoid or reduce this amount greatly.
The process of a medical bill review consists of either a company or a consumer going over the bill line by line and charge by charge to make sure there are no outrageous overcharges, double charges or charges for services that were not received.
If a company performs the review, they may have software that will check the validity of the billing codes and identify overcharges. Then a specialist will go over what the software detected, noting anything that is indeed inaccurate. Auditors will also compare the medical records with the bills to find other errors. Many overcharges are pinpointed by doing this, because services are sometimes billed but never received. In those cases, they are listed on the bill but absent from the medical record.
Thankfully, the process of medical bill reviewing is catching on, and more people are realizing just exactly what the auditors have known all along. Whether the errors are intentional or not, no one deserves to be forced to shell out even more money than what is already necessary for their healthcare.
Operating Room and Recovery
In a hospital, there seems to be ample opportunity for overcharges and errors in the operating room. For instance, operating rooms and recovery rooms are typically billed by the minute. Accurate records of the time must be kept, because often, the patient is billed for more hours than were actually spent in either of these areas.
Also, there are instances when a patient is ready to leave the recovery room and go back to their regular hospital room, but because the hospital is understaffed and no one is available to take them, they are billed by the minute while they wait – very often for an hour or longer.
Up Coding
Up coding is another issue that medical bill auditors find quite frequently. With these issues, a hospital will use an inaccurate billing code, charging more for the service or procedure than necessary. Each procedure has its own range of billing codes, and if the proper one isn’t selected, the patient or insurance could get billed for a much more severe version. For example, if a patient comes in with a cough and is treated for Bronchitis, the diagnosis code billed might be for Pneumonia.
Non-Billables
Non-billable items are some of the most common mistakes on medical bills. These are services or items that may already be included in another charge. For instance, the cost of surgery should include the cost of the supplies to perform the surgery, but if a charge for materials or tools used in surgery appears separately, this could be a non-billable item that should be disputed.
Duplicate Charges
Duplicate charges are all too common among medical bills. They are closely related to non-billables as most non-billables are being duplicated. But often times, duplicates are much more blatant. A patient may receive medication three times per day while in the hospital, but the bill may have it listed as being given six times in a given day. Knowing that such doses are not only lethal but out of the regular intervals, the auditor would catch on and dispute the charges.
Level of Service
Much like up coding (only much more obvious), errors regarding the level of service received are also common among medical bills. For instance, say the patient in the example above gets their prescription for an inhaler, and the doctor decides to go ahead and do a breathing treatment before he discharges the patient. Billing this event as an emergency life-saving procedure would be an example of billing for the wrong level of service. Yes, they gave a breathing treatment, but only as a precaution – not as a means of saving the patient’s life in an emergency.
Price Gouging
We understand that supplies and staffing all cost money and that to stay in business, hospitals need to make a reasonable profit. However, one thing that is rubbing many auditors, insurance companies and patients the wrong way is charging outrageous amounts of money for simple services and supplies. A single dose of Advil may cost the hospital a few cents.
With labor, a reasonable profit and the little paper cup in which they are dispensed (which also costs a few cents), we could expect to pay a few bucks for taking Advil while in the hospital, which is still quite a profit. However, when an auditor comes across a $75 charge for an Advil, it becomes more evident why medical bill reviewing is so important.
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This is by no means an exhaustive list of all the errors that can be found on a medical bill, but it is definitely representative of the outrageous charges one can pay if they aren’t aware of the likelihood of hospital billing errors. Companies and individuals alike are benefitting from having someone on their side to ensure the already expensive bill isn’t more than it should be. Otherwise, insurance companies pay more than necessary, which drives costs of coverage through the roof for everyone.
With medical bills being such a huge financial strain on our economy, and one of the main reasons for bankruptcy, it’s definitely worth a look. With medical bill reviewing, overcharging for care doesn’t have to be accepted. Thankfully, this rising awareness is making more hospitals and doctor’s offices take precautions to ensure bill accuracy and, in some cases, approach their billing practices with higher levels of integrity.
