8 Common Medical Billing Errors

8 Common Medical Billing Errors

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Medical billing errors are more common than one might think, and they could be costing your healthcare practice money. Millions of Americans may be overpaying on their medical bills due to common billing errors. Whether it’s incorrect information, such as a wrong insurance identification number, or it’s inflated quantity of provided services, errors can and do happen.

According to the Medical Recovery Services company, a healthcare facility that helps patients identify and correct their medical bills, most medical bills have errors. In fact, they have found that 8 out of 10 hospital bills contained numerous overcharges and mistakes. To protect the consumer, the medical billing company should be aware of common billing errors, and have a safety guideline to protect against these. Here are the 8 most common medical billing errors.

Number 1: Duplicate Charges

When a patient receives the itemized bill (explanation of benefits or EOB), carefully check for duplicate charges. Billers should make sure the patient is not billed twice for a procedure or services. If there is an itemized bill, duplicate charges are easy to spot.

Number 2: Canceled Procedures or Tests

A patient may be charged for a procedure or test that ended up being canceled. To make sure this does not happen, the medical biller must carefully review the itemized bill before it is sent to the insurance company for payment. If a patient is wrongfully overbilled, the biller should review the healthcare record to prove that the services was not received.

Number 3: Incorrect Patient Information

It is important that the medical billing personnel have accurate patient information. Small errors could impact reimbursement. This includes incorrect name spellings, policy number misprints, and wrong insurance identification numbers. These errors can lead to a claim denial, or worse, the patient could be billed for the entire encounter.

Number 4: Upcoding Charge

A hospital may inflate a patient’s diagnosis to one that represents a more complex procedure. This upcoding incident would lead to a higher medical bill for the patient. For a patient who receives the lowest level of emergency department services, but is billed at a higher level, the healthcare provider could be held liable.

Number 5: Unbundling of Charges

Unbundling charges means the separation of charges that should have been billed using the same procedure code. This common mistake may be hard to identify. Certified medical bill coders will reference the National Correct Coding Initiative created by the Centers for Medicare and Medicaid Services, should they suspect this type of mistake.

Number 6: Balance Billing when In-Network

Balance billing when in-network occurs when the healthcare provider bills for charges other than co-insurance, co-payments, or other amounts assigned by the insurance company. Balance billing is not allowed when the care was provided by an in-network doctor or hospital, but it can occur when you are treated out-of-network for primary care. Doctors may set the rate and bill the patient for anything over what the insurance company covers.

Number 7: Incorrect Quantity

A competent medical biller will make sure the patient is not charged extra for an incorrect quantity of medications, products, or items. This mistake occurs when an extra “0” is placed at the end of a number by a medical biller.

Number 8: Operating Room and Anesthesia Time

If a patient undergoes surgery, the medical records should reflect how long he/she was in the operating room or under anesthesia. Patients are typically billed in 15-minute increments for operations and anesthesia services. Mistakes can quickly add up if this time is billed inaccurately.

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