Common Errors in Medical Billing
The healthcare and medical industries depend heavily on medical billing and coding. when a patient visits a doctor or other healthcare professional, and their insurance is billed after the visit for insurance credentialing services. Government rules have changed as a result of the significant changes taking place in the healthcare industry, which therefore affects coders. Therefore, there are many opportunities for misunderstandings and medical billing errors.
Errors in medical billing and coding are common, but they are often costly. Errors can be expensive, whether they involve repeated charges, inaccurate information (such as a false insurance ID number), or an exaggerated number of services that medical billing companies provide. Any one of these errors might lead to thousands of dollars to correctly add to your bill or your health insurance coverage completely denying the charges.
Recognize common errors in medical billing
You will receive an invoice outlining your financial obligations following your visit to your healthcare practitioner. Make sure to ask the hospital or your doctor for an itemized bill or statement, though, as errors are frequently made. You can thoroughly examine each service for which you are being charged in this manner.
You should also receive an explanation of the benefits statement from your health plan if you have health insurance.
1. Look for any overlapping charges.
Verify the charges to be sure you weren’t charged twice for the same service or treatment. An itemized bill should make it much simpler to find.
2. Aborted experiments or processes
The test or procedure that was postponed may have still been charged to your account. Reread your itemized medical bill to make sure this doesn’t occur. In order to prove that you did not use the service and to challenge the fee if you believe you were unfairly overcharged, gather all the appropriate documentation.
3. Inaccurate patient data
Medical bills frequently contain inconsequential mistakes like misspelled names or misprinted policy numbers. If your insurance ID number is incorrect, your health plan may deny your claim or send you the full amount due.
4. Up-coding fees
A hospital may exaggerate a patient’s diagnosis to indicate a more complex surgery, which would result in a greater medical cost. The lowest level of emergency department services, for instance, might have been provided to you, but you might have received the highest level of billing. In reality, this is a dishonest, unlawful activity, so you should demand that your healthcare professional reverse the charge right away.
5. The unbundling of fees
The separation of the charges that ought to have been billed under the same procedure code is the topic of this error. Unless you are a professional medical bill coder, it might be difficult to spot this kind of inaccuracy.
6. When in-network, balance billing is used.
This occurs when a healthcare provider sends you an invoice for expenses other than co-payments, co-insurance, or any other amount above what your insurance company assigned. When the care was provided by an in-network hospital or doctor, balance billing is frequently incorrect.
Compare the bill with your EOB if you believe you have been balancing billed. Since doctors can decide how much to charge you and can bill you for any expenses that exceed what your insurer will pay, balance billing occurs most frequently when patients receive non-emergency treatment outside of their network.
7. An incorrect amount
Check to see if an improper quantity of commodities or medications was charged to you extra. The billing department may have merely added an extra “0” to the end of a number to cause this error.
8. Surgical time and anesthetic
Check your medical records to learn how much time you spent in the operating room or under anesthesia if you had the procedure. Errors here can mount up quickly because patients are typically invoiced in 15-minute intervals in these situations.
You can save thousands of dollars in unnecessary expenses by keeping an eye out for some of the most typical blunders in medical billing practice.
1. Continue to Network
Making ensuring your providers are part of your network is the greatest way to prevent billing surprises, according to McClanahan. You shouldn’t rely on the plan’s directory because the information there may be outdated. To verify that the doctor is a part of your network, call the doctor’s office and mention your plan name and group number. Additionally, confirm which local hospitals accept your insurance.
Your visit will be paid by the insurance at a lesser rate with an out-of-network