Pat Palmer, founder and CEO of Medical Recovery Services and Medical Billing Advocates of America, did not realize how long her medical bill auditing and medical bill advocacy organizations would be in business when she began them in 1994 and 1997. But after 20 years of her business not just surviving, but thriving, she can be assured of 20 more.
There are lots of reasons why Pat Palmer’s two organizations have been so busy. The instances of overcharging have increased exponentially in recent years. And just when we think we couldn’t possibly find higher amounts of over-charging on consumer’s bills, we are proved wrong.
What are the areas where we are seeing the most overcharges lately? According to Pat, you should carefully scrutinize all bills, but pay particular attention to your medical bills when you have been to an emergency medical facility for a trauma, when you have been treated at a medical facility for more than 24 hours but were never admitted as an inpatient, or when you have had a surgery or procedure in which robotics were involved (sometimes called a computer-assisted surgery).
In addition to over-charges on medical bills, we are finding more and more instances of improper reimbursement from insurance companies. Items are not being double-checked by the insurance providers and bills that are riddled with over-charges are being paid by insurance companies.
But price gouging and abusive medical billing practices aren’t the only things that are causing Americans to question their medical bills.
The implementation of the Affordable Care Act has left numerous consumers confused and under-insured in many cases. Many consumers are uninformed, for whatever reason, about their coverage under new insurance plans under the ACA. Additionally, many Americans fall into a category in which they make too much money to qualify for some of the less expensive insurance plans under the ACA, but can’t afford the premiums on the “better” ACA plans that provide more coverage.
This leaves them with no choice but to opt for a plan in which they can afford, but leaves them with an extremely high deductible. Mix a high deductible with a plan which you don’t understand and add an instance in which the insurance company claims they don’t cover something in which you thought they would, and you have a recipe for financial disaster.
Furthermore, as the penalty increases for not being covered by an approved health insurance program and more people begin to participate in the ACA, we expect to see more confusion until the kinks are worked out of the system.
The execution of a new coding system is another huge hurdle coming our way. When ICD-10 is implemented, we expect to see a landslide amount of incorrectly coded medical bills. Unfortunately, it just makes sense that if we have trouble coding correctly with approximately 14,000 codes, that we will have more incorrect coding when the amount of codes is quadrupled.
Remember, ICD-10 was set to begin in October of 2014, but was pushed into 2015 to give medical staff more time to prepare. This was not the first delay in implementation. Clearly, medical staff is not ready yet for ICD-10 to begin (meaning there will be errors).
But as the healthcare landscape continues to change (whether for better or worse), Pat Palmer and her team of medical billing advocates will be ready to help you along the way. Don’t hesitate to contact us if you have any questionable medical bills.
