- 80% of medical bills are inaccurate
- Billing errors in the US cost $68 billion annually
- Medical billing errors can result in a long time for reimbursement and lost revenue for healthcare practices.
Statistics show that 80% of medical bills have errors and healthcare fraud, causing healthcare providers revenue loss and patients to pay extra out-of-pocket.
Once you receive care, your insurer will give you an explanation of benefits, and if you did not receive a statement or an itemized bill from the healthcare provider, ensure to request one. This way, you can cross-check EOB with the bill and verify how much your insurer has paid, what product or service the healthcare provider billed for, and what you are being billed for.
If you had been rendered a service that was not covered and you don’t agree, the following are some common medical billing errors that can result in claim denial.
6 Common Medical Billing Errors in 2023:
Medical billing and coding is an important and complex step that every healthcare organization must perform to fairly and accurately bill the patients for the care services provided to them. However, the process doesn’t go as smoothly as it sounds. Here are some medical billing errors that patients encounter from time to time, resulting in their claim denial.
- Coding Errors:
Medical codes are a language that is used to describe medical treatments, diagnoses, costs for each treatment, and reimbursements. If incorrect codes are applied to a medical bill, it can increase the cost.
For instance, if a medical coder mistakenly or deliberately codes a 15 minutes regular checkup as a 25 minutes diagnostic session, the patient will end up paying higher than their actual bill. Therefore, it is essential to dig into the details to check for errors that might have occurred during medical coding or billing.
Upcoding is a category of coding error that often happens when healthcare entities use a code for more severe illnesses than what the patient was diagnosed with, resulting in higher bills.
- Billing of Refused Services:
Often, medicines, procedures, or tests you have refused to take or the healthcare professional has canceled may still appear on your bill and get you charged mistakenly. Therefore, it is advisable to carefully check each bill to see whether the procedures or medicines listed on the statement were rendered.
- Code Unbundling:
Code bundling is another common medical billing error in which the coder accidentally applies multiple codes instead of one bundle code for the care service as a whole. Preparing medical bills this way will not increase the overall cost of the services but will also result in claim denial.
Unbundling may be a bit complicated to spot, especially for those who are not trained in this field; however, verifying your bill against the list of the codes and getting help from medical bill advocates can save the patients from claim denial.
- Data Entry Mistakes:
Simple typos or clerical mistakes like putting the wrong insurer or making an error in the insurance number can result in claim denial. So if you receive a bill that seems too high, immediately dial your insurance provider to check if the claim was prepared properly.
- Duplicate Charges:
Duplicate charges are another common medical billing error that happens when the biller charges you twice for a rendered service. While mistakes can happen during these procedures, checking the bill before submitting it for a claim is advisable.
Ways to Prevent Medical Billing Errors:
While medical billing errors are common, they are avoidable to a great extent. Following are the precautionary measures to guard against these errors and catch them instantly when they happen.
- Contact your Provider: If you find an error in your bill or find it too high than it actually should be, call your provider and ask them for an explanation. If you find any error along the way, ask them to fix it on the spot.
- Contact your Insurer: If the claim has been submitted with errors, you can contact your insurance provider to help resolve those errors. And if the claim results in denial, you can drop an appeal with the provider to get another review.
- Take help from an Advocacy Group: If you find difficulty disputing medical bills, considering the complexity of their nature, you can enlist the assistance of a medical bill advocate that specializes in disputing errors and negotiating bills.
- Take help from Legal Counsel: While disputing your bills, if you get sued for an outstanding balance, consider taking help from legal counsel, as they can advise you on how to resolve the matter.
While most healthcare practices are now deploying technologies to help bring down billing errors, the problem persists among the providers using conventional billing procedures, posing a significant threat to the patient – including wrong treatments, diagnoses, and procedures. By following the above-provided instructions, patients can minimize the chances of billing errors in their statements and claim denials.