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Spot Common Medical Billing Mistakes in Procedure


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Medical billing and coding are important part of healthcare and medicine industry. When someone visits the doctor or a healthcare practitioner and after the visit their insurance is billed. Now that healthcare world is undergoing a huge change hence; there are changes in the government regulations which reflects in the coders as well. Therefore; there are lots of chances of miscommunication and billing errors.

Medical billing and coding errors are common but; these errors are expensive. Whether there are duplicate charges, incorrect information like a wrong insurance ID number, or an inflated quantity of services provided errors happen, and they can be costly. Mistakes with any one of these issues could result in thousands of dollars being wrongly added to your bill, or a complete denial of charges by your health insurance plan.

Spot common medical billing mistakes

After you visit your medical provider, you will be receiving an invoice telling you how much you will be paying. However, because the errors are common, make sure you request an itemized bill or statement from the hospital or your doctor. This way, you can carefully check each service you are being charged for.

If you have health insurance, you should also receive an explanation of benefits statement from your health plan.

  • Check for the duplicate charges

Check for the duplicate charges; ensuring that you were not billed twice for a single service or procedure. With an itemized bill, it should be much easier to spot.

  • Canceled tests or procedures

You might have been charged for the test or procedure that was canceled. Make sure this doesn’t happen by carefully rereading your itemized medical bill. If you think you were wrongly overbilled, collect all the necessary documents so that you can show that you did not receive the service, so you can dispute the charge.

  • Incorrect patient information

Small errors such as incorrect name spellings or policy number misprints are common on medical bills. If your insurance ID number is wrong, it can lead to a claim denial or a full amount sent out by your health plan.

  • Up-coding charge

A hospital could inflate a patient’s diagnosis to one that represents a more serious procedure, leading to a higher medical bill. For example, you could have received the lowest level of emergency room services but be billed at the highest level. This is actually an illegal, fraudulent practice, and you should ask your health care provider to correct the charge immediately.

  • Unbundling of charges

This error discusses about the separation of the charges that should have been billed under the same procedure code. This kind of error can be tricky to identify unless you are a certified medical bill coder.

  • Balance billing when in-network

This occurs when the health care provider bills you for charges other than co-payments, co-insurance, or any other amount than what was assigned by your insurance company. Balance billing is often wrong when the care was provided by an in-network hospital or physician.

If you think you have been balance billed, compare the bill with your EOB. Balance billing is most common when you are treated out-of-network for non-emergency care, as doctors can set the rate to charge you and bill you for anything over the amount your insurance covers.

  • Incorrect quantity

Make sure you weren’t charged extra for an incorrect quantity of items or medications. This mistake could be as simple as an extra “0” placed at the end of a number by the billing department.

  • Operating room and anesthesia time

If you had undergone the surgery, check your medical records to see how long you were in the operating room or under anesthesia. Because patients are usually billed in 15-minute increments in these instances, mistakes here can add up quickly.

By looking out for some of the most common errors in medical billing mistakes in procedure, you can avoid paying thousands of dollars in unnecessary costs.

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