Two years ago, a Medicare fraud crackdown revealed that about 70 billion dollars worth of taxpayers’ money are being lost to healthcare fraud, based on a Fast Company report. So we have to ask: as a dutiful taxpayer, are you getting all your money’s worth for the medical services given to you? How much are you actually saving from medical bills reimbursements? Found below are the top five medical billing and coding errors that may be jacking up your bill—whether intentionally committed or not.
Upcoding is a term used for improperly “upgrading” the medical billing code for a diagnosis or service to a level up. An example of upcoding is when the generic medication you’ve been given has been billed for a code for a branded medication, which, more often than not, costs you more.
Unbundling occurs when you are billed for a service that has already been included in a prior package. Here, the service is listed and billed separately from the package it belongs to, causing duplicate or additional billing. You can only find out whether unbundling has occurred by checking if the service descriptions are aligned with the CPT (Current Procedural Terminology) codes. You may also contact the number at the end of your bill to verify the accuracy of these codes.
3. Inaccuracies in Patient Information
Ah, the glorious typo! Who doesn’t make this mistake? However, know that there shouldn’t be any room for errors with regards to the job of a medical coder and biller. A mere typo in the patient’s full name or insurance ID number can cost a patient his or her insurance claims. And as far as claim forms go, fields like date of emergency, disease onset and date of accident shouldn’t be left blank.
You should always make sure that every item on your bill is accounted for. You can choose to double-check the information yourself or consult with a medical biller for it. For further information, check out The Ohio State Medical Association’s list of reasons for insurance claims denial.
4. Duplicate Billing
Often times, duplicate billing occurs when you’re billed for tests, procedures and medications repeatedly—a famous and most common example of which is when your biller bills you for a medication at both the time it has been prescribed and administered to you. Sometimes, it takes a dose of common sense to spot this type of error, but it also calls for serious scrutiny at times. Double-check too if you’re being charged for a bill that has already been billed on your insurance provider.
5. Incorrect/ Mismatched Diagnostic or Billing Codes
The ICD (International Classification of Diseases) codes, the column for which comes right after the CPT codes, are diagnostic codes for the disease you may be treated with. Inconsistencies between the ICD code and the CPT code, which occurs during upcoding or unbundling, may lead to claims rejection. It may go unnoticed, and may certainly work in your favor if the total cost is lower, but then, it may also work against you if the total bill is inflated.
Make sure that your hard-earned money is going into the right pockets by being a smart payer. Check out our blog from time to time to keep yourself posted on topics about medical billing and coding concerns.