Medical billing errors are becoming more and more common in the United States. As the government gets more involved in the health care field, and the disconnect between medical coding professionals and healthcare providers grows wider, the miscommunication that occurs is extremely common, and could be artificially inflating your medical bill.
Here are 7 common medical billing errors to watch out for:
1. Upcoding – Upcoding occurs when a medical billing code is improperly changed to one which represents a more severe diagnosis or treatment. This is illegal and can cause your bill to be inflated. Common examples of upcoding include things like coding for a name-brand medication when a generic one was used, or coding a regular office visit as inpatient care.
2. Unbundling – Unbundling occurs when charges that normally fall together under one billing code are listed separately. This can make your bill a lot higher because the items should be billed at a package rate. An example of unbundling can occur if multiple medical tests which should fall under the same code are billed separately. Consider speaking with a medical billing advocate to help you determine if your bill contains these errors.
3. Balance Billing – Balance billing occurs when you receive a medical bill for the leftover “balance” after your insurance company negotiates a price with your hospital or care provider. You should check with your insurance company about whether or not all of the hospital’s charges are covered under your policy. If they are, then this balance bill is illegal, and you should not have to pay for it.
4. Duplicate Billing- Duplicate billing occurs when procedures or services are billed multiple times. For example, both a doctor and a nurse may have indicated that a particular medication was given to you without knowing that the other had already billed for the service. It’s possible that a medication was billed both when prescribed and when administered. There have even been instances where patients were billed for multiple “first days” in the hospital (which commonly cost more than subsequent days during the same hospital stay.) Duplicate billing is one of the most common reasons why your medical bill is so high.
5. Lack of Medical Necessity - If your care provider fails to provide the coder with enough information about your diagnosis, then the wrong medical diagnosis code could be used in your bill. Medical billing errors like this can lead to your insurance company denying your claim because of “lack of medical necessity”, and can leave you being charged by your care provider, directly.
6. Incorrect Patient Information – Similar to #5 above, any misspelling of your name or a typo in your insurance ID can lead to your insurance company rejecting your claim. And these medical billing errors are quite common, due to the fact that most medical bills can be influenced by dozens of people. A mistake entering your information by any one of them can simply be passed down the line, and can cause problems when your claim is submitted to your insurance company.
7. Mismatched Treatment/Diagnosis Codes – When a medical biller upcodes your diagnosis, but leaves your treatment code alone, your insurance company will typically reject your claim due to the mismatch between the treatment and diagnosis codes. This is an especially ugly medical billing mistake if it goes unnoticed, because not only will your claim be rejected for the mismatch, it will also have been inflated by the upcoding.
If these or any other medical billing errors have left you with an unfair or illegitimate medical bill, do not despair. You can earn how to fight your medical bills, and get your medical expenses back on track.
Or simply contact Medical Bill Rehab for a free analysis of your medical bills. As much as 80% of all medical bills have errors, and there is no reason to pay them if they are not accurate. Call us now and let us help.