Errors in Medical Billing — What to Look For

Errors in Medical Billing 

When an employee or their loved one becomes ill or has an accident, the main focus should be on getting answers, treatment and care. The last thing an employee should have to think about is their bill, and although many employers have attempted to contain costs for employees, medical costs can be top of mind when visiting the doctor or hospital. Errors in medical billing is a reality that many employees face.  

After a well-child visit to a pediatrician recently, a patient was surprised when they received the bill. The doctor’s appointment entailed the typical well-child services including immunizations and developmental measurements. However, when reviewing the bill, one charge stuck out: asthma consultation. The patient recalls respiratory issues were not discussed, yet the charge was clear. And it came with a $1200.00 price tag.  

Each one of us who interact with medical systems could be at risk of receiving charges for conversations, procedures, or equipment usage that didn’t occur or wasn’t performed. Medical bills can be complicated to understand, especially when unexpected charges make their way onto an invoice. Knowing if those charges are accurate is essential. 

ERRORS DO HAPPEN.

Medical bill errors can – and do – make their way through billing and out to insurance companies and employees. Here are a few errors to watch out for: 

• Coding errors. Most healthcare providers use codes to show the care a patient receives during a visit. These codes can represent procedures, supplies, discussions, or how long an appointment takes. For example, a 15-minute visit will have a different code than a 30-minute visit. Entering the wrong code or mistakenly adding codes can increase a patient’s bill quickly.
• Clerical errors. Simply entering the wrong insurance company or patient number into the wrong area can create increased bills or denied claims.
• Canceled or refused treatment. Sometimes medication, supplies or tests that are refused during an appointment can mistakenly be put through on an invoice.
• Duplicate charges. Being charged for the same procedure, medicine or supply twice can occur quite easily, especially when the item list is lengthy or a hospital stay was long.
• Unbundling. Instead of billing two medical procedures together, they are billed separately. This can increase the cost, resulting in higher reimbursement for the healthcare provider.

Unfortunately, patients are at risk of being taken advantage of because many do not double-check coding and may not realize they have been overcharged or billed for items they didn’t have, use or discuss. This can result in higher medical bills for many families, as well as an overall increase in the use of a company’s benefits program. One patient had a nursery charge of $3700 for a visit that was 20 minutes long. Whether that was a mistake or intentional, these charges need to be noticed and corrected. 

Many facilities will adjust these charges if discussed appropriately with the correct knowledge and proof, however, the errors need to be noticed first. Having a benefits advocate can help employees feel supported and give them someone to talk to about what is fair, and what is not. 

A LITTLE KNOWLEDGE GOES A LONG WAY.

A benefit advocate can also help employees before a procedure. Determining what their plan will cover, which doctors or facilities are in their network and help prepare employees for appointments by getting written estimates for treatment. An estimate can show an employee what costs to expect, making unexplained charges more noticeable. If there are any questions, an advocate can help them determine what the cause of the increase is and if it can be corrected. 

A benefit advocate can be a tremendous aid to employees. High medical bills do happen, but the amount isn’t always what should be paid. If you would like to know more, don’t hesitate to reach out. Let’s chat today!