Who Pays for Medical Billing Errors?

Who Pays for Medical Billing Errors?

The average patient can find around $1,000-$2,000 worth of medical billing errors in his medical bills over a five-year period. Healthcare services are expensive enough without dealing with medical billing errors that make you pay for services you did not receive.

Medical billing error rates have been reported as high as 60%, according to Consumer Reports. What’s more, only around 5% of people notice medical billing errors. Most people just pay these bills without noticing them.

Check the Bill against the Explanation of Benefits

To avoid paying for medical billing errors, the patient should check the bill against the explanation of benefits (EOB), which is sent from the health insurance provider. The EOB will list the date of service, medical provider, claim identifier, what insurance company paid, what was billed to the insurance, what cost were not allowed and why, and what the patient owes the healthcare agency or entity.

Checking the EOB is the first step to assure it matches the bill. Even when the EOB matches the bill, this does not mean that billing errors did not occur. Matching data and information only means that the insurance company verified what the patient owes the medical provider.

If a service is billed, and the patient never received the service, then a billing error has occurred. Every medical procedure has a unique code, and if coding error occurs, the corresponding bill may be wrong.

Our professional billing company will assist patients in validating healthcare bills. The patient may not understand all the codes on the bill, so a medical billing professional must explain this. It may take a little time, but it will ensure a happy patient who returns to the healthcare practice.

Avoiding Medical Coding Errors

There are some things a medical billing agency should do to avoid medical coding errors. In addition, the healthcare provider should also be aware of billing mistakes. To avoid medical coding errors, the billing professionals should:

  • Be diligent – A medical billing coder is a detailed-oriented professional. Billing consists of many choices to make each day. Avoid many medical coding errors simply by double-checking your work. This involves reading over every medical report twice and not becoming too familiar with a particular set of procedure codes.
  • Communicate – Medical billing professionals do not get many opportunities to talk with healthcare providers. However, the billing professionals should make plans to develop proper relationships with the provider’s office so they can communicate with them often. Regular communication with the doctors will make it easier for the biller to clarify issues on medical reports.
  • Stay educated – Every year, the world of billing and coding changes. Billing professionals need to remain up-to-date in regulations and billing changes. Update coding software to the latest versions, and subscribe to billing periodicals and continuing education courses.

Common Billing Errors

The most common billing errors are:

  • Repeat billing – Ensure the patient has not been charged twice for the same procedure, medications, or supplies.
  • Length of stay – Check the dates of the patient’s admission and discharge. Make sure he/she was charged only for days of hospitalization.
  • Right charge for room type – Make sure the patient was billed for a private room or a double one.
  • Time in OR – Make sure the patient’s time in the operating room is documented and billed accurately.
  • Upcoding – This occurs when a doctor changes an order for a service or medication from an expensive version to one that costs less.
  • Keystroke mistake – This is an innocent slip on the keyboard, adding an extra number, which results in overcharges.

MPMR offers first rate medical billing and coding services nationwide to all types of practices. The typical practice experiences a 30% increase in revenue within 6 months! Call us today.

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