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8 Common Medical Billing Errors

Billing is never an enjoyable process. For anyone. On average, 40 percent of small businesses are 60-plus days delinquent on at least a third of their receivables – and unclear or incorrect invoices can certainly be at fault.

In the medical field, reports say that upward of 80% of invoices are overcharging patients. To ensure you’re not making errors and overcharging your patients, keep in mind the following tips (or share these tips with them and build further trust):

1. Double charging:

Whether you refer to it has double charging or duplicate billing, this error occurs when patients are billed more than once. Human error is the most common example, say, through a doctor and nurse not fully communicating to each other that a particular medication was given – thus a bill could be incurred when the medication was prescribed and administered.

Another common example is billing multiple “first days” in a hospital, which often cost more than subsequent days during a hospital stay. Patients should always carefully read through invoices,  as double charging is the most common reason for unexpectedly higher medical bills. To combat this issue, insure your patients receive an itemized bill, making it easier to spot duplicate charges.

2. Upcoding or mismatched codes:

Upcoding occurs when a medical billing code is improperly changed to one which represents a more severe diagnosis or treatment. While the most common occurrences include things like coding a regular checkup as inpatient care or coding for name-brand versus generic medication, the error of upcoding is still a serious offense. To your patients, it’s basically like getting billed for an expensive bottle of Advil instead generic Acetemenophin….but much worse. And highly illegal. Patients should ask their healthcare providers to correct the charge immediately.

Mismatched codes are another similar error. When a medical bill upcodes your diagnosis, but a patient’s treatment code is left alone, the insurance company will typically reject the patient’s claim due to the mismatch between the treatment and diagnosis codes. This is a double whammy; not only will a patient’s bill be more expensive, but the claim will also get rejected.

3. Unbundling:

Unbundling is the separation of charges that are normally charged under the same billing code. Instead of receiving a package rate for, say, multiple tests of the same code, patients who experience unbundling on their medical bill can often pay multiples of their original bill.  This type of mistake can be tricky to identify, and patients who experience unbundling should reach out to the National Correct Coding Initiative by the Centers for Medicare and Medicaid Services for further advice on arguing the charges.

4. Incorrect quantity:

This mistake could be as simple as an extra “0” placed at the end of a number. Patients should carefully check quantity to make sure they weren’t charged extra for an incorrect amount of items or medications. Talk about a headache for the patient.

5. Incorrect info:

Another of the most common billing errors are simple misspellings and misprints, including incorrect names or policy numbers. Claim denials or being bill for a full amount can occur because of a simple incorrect insurance ID number. Talk about a headache.

The main reason these errors occur are because of how many hands influence a medical bill – sometimes up to a dozen people have something to do with it. One mistake entering incorrect information can be passed down the line just like the childhood “telephone” game, causing severe problems when a patient’s claim is submitted to their insurance company.

6. Balance billing:

Balance billing occurs when a health care provider bills the patient for charges other than co-pays or any other amount than what was negotiated with the insurance company. Balance billing is most common when a patient is treated “out-of-network” for non-emergency care, as doctors can set the rate to charge the patient and bill them for anything over the agreed amount. 

Patients should check with their insurance company about whether or not all of the hospital’s charges are covered under their policy. If they are, then this balance bill is illegal, and patients should not have to pay for it.

7. Overcharge time:

After undergoing a procedure, patients should check medical records to confirm how long they were in the operating room or under anesthesia. Patients are usually billed in 15-minute increments, therefore, mistakes can add up quickly.

8. Canceled procedures:

Patients can sometimes accidentally be charged for a test or procedure that ended up being canceled. They should make sure this doesn’t happen by carefully reviewing their itemized medical bill. If a patient thinks they were wrongfully over-billed, they should collect all the necessary documents to prove they did not receive the service, thus disputing the charge.

Related: How Do I Fix Medical Bill Errors?

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