Home > Education Center > December 2016 > How to Spot and Fix Medical Billing Mistakes

How to Spot and Fix Medical Billing Mistakes

Posted: 12/22/2016 9:34 AM by Interim HealthCare

Dear Savvy Senior,
After a recent hospital stay, I have a stack of confusing medical bills at home I need to decipher. I’ve heard these bills frequently contain mistakes. How do I spot them to ensure I’m not paying more than I need to be?
Cautious Carol

Dear Carol,
Medical billing errors and overcharging is not uncommon. According to the American Medical Association, 7 percent of medical bills in 2013 had errors, and other groups estimate that figure to be much higher. Unfortunately, untangling those mistakes is almost always up to you. Here are some tips and tools that can help.

Check For Errors
To help you get a grip on your medical bills and check for errors, you need to familiarize yourself with what your insurance does and doesn’t cover. Then you need to carefully review the explanation of benefits from your insurer, and the invoices you receive from your doctor, hospital and/or outpatient facility providers.

These invoices need to be itemized bills detailing the charges for every procedure, test, service and supply you received. If you didn’t receive an itemized invoice, request it from your health care providers. And if the invoices contain any confusing billing codes or abbreviations that you don’t understand, ask them for an explanation. You can also look up most medical billing codes online by going to any online search engine and typing in “CPT” followed by the code number.

Once you receive and decode the invoices, keep your eyes peeled for these mistakes:

Typos: Incorrect billing codes, a misspelled name or a wrong policy number.
Double billing: Being charged twice for the same services, drugs, or supplies.
Canceled work: Charging for a test your doctor ordered, then canceled.
Phantom services: Being charged for services, test or treatments that were never received.
Up-coding: Inflated charges for medications and supplies.
Incorrect length of stay: Most hospitals will charge for the admission day, but not for day of discharge. Be sure you’re not paying for both.
Incorrect room charges: Being charged for a private room, even if you stayed in a semi-private room.
Inflated operating room fees: Being billed for more time than was actually used. Compare the charge with your anesthesiologist’s records.

To make sure the charges on your bill are reasonably priced, your insurance provider may offer an online price transparency tool, or use the Healthcare Blue Book (healthcarebluebook.com) or Guroo (guroo.com). These are free resources that let you look up the going rate of many procedures, tests or services in your area.

Make Corrections
If you find errors or have questions about charges, contact your insurer and your health care provider’s billing office. When you call, be sure you write down the date, time and name of the person you speak to and a summary of the conversation, in case you need to refer back to it at a later time.

If there’s a billing code error or some other mistake that’s easily correctable, ask your health care provider to resubmit a corrected claim to your insurance company.

Get Help
If you aren’t able to resolve the dispute on your own, you may want to consider hiring a medical billing advocate to work on your behalf. To find someone, try sites like billadvocates.com or claims.org. Most advocates charge an hourly fee – somewhere between $50 and $200 per hour – for their services, or they may work on a contingency basis, earning a commission of 25 percent to 35 percent of the amount they save you.

If you’re a Medicare beneficiary, another resource is your State Health Insurance Assistance Program (SHIP). They provide free counseling and can help you understand your medical bills and Medicare coverage. To find a local SHIP counselor visit shiptacenter.org, or call 800-633-4227.