March 25, 2016

Why Do Medical Bills In the US Contain So Many Mistakes?

Why Do Medical Bills In the US Contain So Many Mistakes?

The healthcare industry in the U.S. has a bad reputation for inaccuracies in billing. The burning question everyone wants to know is what causes our medical bills to have so many errors. Here are a few answers:
Why do medical bills in the US contain so many mistake


Human Error While Entering Billing Codes  


In many cases, there’s no malice intent when errors pop up on your bill. Medical billing isn’t a perfect science. To better understand the process, here’s an overview of how it works.


Doctors keep a chart of notes with tests, procedures, treatments or medication you receive during a visit. Each one has a special medical code. The job of a medical coding specialist is to translate each note from your chart into a code that appears on your final bill.


There’s always an opportunity for error in data-entry especially if a medical coder deals with a high volume of patient records on a daily basis. Duplicate codes and the wrong quantity entered for medications are two very common oversights. Thankfully, they are also easy to catch if you review your bills thoroughly.

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Charges for Cancelled Procedures


Scheduled medical tests, procedures or treatments don’t always go as planned, but you can get charged for them anyway. This can happen when a medical coder uses what’s on your chart beforehand to create your bill. Here’s an example:


I went to the orthodontist to have my wisdom teeth removed a few years back. The doctor planned to do another cosmetic procedure during the surgery. After finishing up, he happily announced the second procedure was actually unnecessary and not performed.


When I got the bill a few months later the second procedure that didn’t happen was still on the bill and not covered by insurance. The doctor’s office claimed the procedure was recorded on my chart. It was in his notes, but the notes taken prior to the surgery. Only after a few weeks of back and forth were the charges removed.


An Outdated Medical Coding System


Up until last October, the U.S. healthcare industry was using a dated version of the standard medical coding system. It was over 30 years old to be exact. Of course, a system that was created before modern medicine is bound to have some areas that need improvement.


The revised edition of the system is supposed to better describe diagnoses and treatments of the 21st century. Hopefully, this will result in more accurate billing in the future.


(For an in-depth overview of the improvements between the old and new coding system, check out this pamphlet from the Centers for Medicare and Medicaid Services.)


Up-charging or Unbundling of Procedures


Sadly, in some instances, the providers we trust make errors intentionally to take advantage of patients. Two such errors being up-charging for care and unbundling of medical codes.


Up-charging happens when a healthcare provider overstates the severity of your condition or treatment so they can charge you more. Again, you can catch these errors by reviewing billing codes with your provider or doing your own independent research. If you notice an unnecessary test, medication or procedure, contact your provider immediately to have it removed.


Another instance where someone can increase your bill is purposefully unbundling medical codes. Certain codes are bundled together in one package to bring down the cost. Charging individual codes instead can make your bill higher and puts more money in their pocket.


Unbundling is more challenging to catch if you’re unfamiliar with medical billing, but we can help you there. If you want an expert to give your bills a once over, reach out to our billing advocates. We’ll review your bill and we won’t charge you a dime unless we can save you money.

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Taylor Gordon
About the Author
Taylor Gordon

Taylor K. Gordon is a freelance blogger and personal finance junkie who lives in the nation's capital. She documents her path to financial freedom and adventures in solopreneurship on her blog, Trendy Cheapo.