Various online reports indicate that two-thirds to three-quarters of medical bills in 2020 contained errors. With those bills routinely totaling thousands, tens of thousands, and even hundreds of thousands of dollars, it certainly makes sense to check them for errors.
The medical coding and billing system is complicated and even trained billers and coders make mistakes. Having a professional revenue cycle management company take care of medical billing prevents most errors. Medcare MSO also has a senior biller “scrub” each claim before it is submitted, checking for any of the common mistakes that happen and ensuring all required information is filled in. This extra step has proven to greatly reduce errors and improve collections.
A Quick Overview of Medical Bills
In addition to receiving a bill from your medical provider, you should also receive an explanation of benefits (EOB) from your insurer. The bill will say how much you owe the provider based on what they charge for services minus the amount paid by the insurer. That part of the math is simple, but understanding how the insurer determined how much they would pay isn’t necessarily so straightforward.
The medical codes use specific language and codes for each item. To keep things clear, the EOB will use that language, even though it is not easily understood by the patient. You can call your provider or the insurer and ask for an explanation of the items on the bill that you aren’t sure about. The internet is another handy resource for clarifying terminology, and a quick search may clear things up.
It is a good idea to do your homework and verify that each item on an EOB is correct because it can be much more difficult to get a refund if you figure out later that you overpaid.
Common Errors in Medical Bills
Sometimes, due to a person having multiple insurers or oversight, a service or treatment doesn’t get submitted to the insurer at all. In that case, you will be charged the full “retail” price charged by the provider. Your insurer will have negotiated a lower rate with the provider if it is a service that is covered.
When a claim is submitted, it may be rejected by the insurer for even the slightest errors. These can include transposed numbers, misspelled names, and missing dates. Insurers don’t try to figure out what is wrong with the claim that gets sent to them, they just reject it. Your practitioner will usually figure out what is wrong and resubmit the claim, but you should make sure that no claims for treatments or visits that should be covered are rejected. When you get a bill or EOB, check all the basic info for correctness.
Another way insurers avoid payment is to deny the claim, in full or in part, and say that they are not responsible for it. In this case, they agree that the information on the claim is correct, but they are saying your plan does not cover it. The EOB should give a reason, and you should pay attention to what that is.
Often an item will be denied as not being medically necessary, and there may be a different or additional code that needs to be included in the claim, or the provider needs to submit evidence of necessity.
Pay attention to the items on the bill to make sure they were all received. In the case of multiples, make sure you are charged for the correct number. Medical equipment is another area to check to be sure you are only paying for what you received.
It has been known to happen that numbers were transposed, or an extra digit was accidentally inserted. An extra zero clearly makes a huge difference, so make sure each amount is about what you expected based on what you had been told before and during the visit.
What to Do When You Find an Error
Depending on what the problem is, your provider may be able to file an appeal. However, there are times when you must do it. The EOB will usually include instructions for filing an appeal. Be careful to follow the instructions, insurers are very picky about the details.
If the insurer disagrees, but you still believe you are right, you can request an independent review. The Patient Advocate Foundation is a resource that provides several different kinds of support. If the bill is very high, it may be worth hiring a medical billing advocate. Their fees may be high, but if they save you thousands of dollars overall, it can be well worth the investment.
Persistence pays off, and is needed to successfully challenge medical billing issues. If you see any problems, track down the information you need to fully understand the bill. Then if it isn’t correct, start taking the steps above to get the bill corrected. Let your provider know if you are working on getting an insurer to change something. They will usually be amenable to working with you, so don’t just ignore the bill and get sent to collections.
Medcare MSO provides full-service medical billing for small and large organizations. Our process has developed over the decade we have been in the medical billing business, and has become so efficient, we can guarantee our clients that we will increase their revenue. Call 800-640-6409 to talk to an expert who can answer any questions and get your medical business started on the road to better revenue flow.