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Reading between the Lines: Understanding Your Medical Bill

James Palinsad August 7, 2013 Comments Off on Reading between the Lines: Understanding Your Medical Bill
Reading between the Lines: Understanding Your Medical Bill

Ignorance is bliss, but not when it comes to dutifully paying your medical bills.

Some people don’t even bother examining their medical bills. But with rising medical costs, gone were the days when one can simply churn out the greens or swipe his or her plastic at the cashier. Everything has to be accounted for—you could be saving up to a whole month’s rent by simply going over your medical bill.

So, do you know how to read it?   

Medical bills may be formatted differently—column titles or categories may vary in order—but they essentially cover the same basics. But, no matter how much the rows or columns have been rearranged on our bill, they still contain esoteric codes and numbers that are unfathomable for the rest of us. And this is without even taking human error into account. Here are a few things to keep in mind:

1.    The first four columns are easy to remember and are constant.

The first few columns show the date the services have been recorded, your patient number (Pat#), and your doctor’s office assignment (Prv#). The last one, the Msg column, indicates whether services rendered by your healthcare provider had been charged on you or your insurance provider.

2.    Examine the Service Description.

Service descriptions may include anything from urinalysis to blood tests done on you. Check your paperwork and find out whether these services have really been performed on you. You don’t want to be paying for inexistent bills. For more info on medical terminologies, visit this link.  Or visit medical terminologies courses.

3.    Make sure the CPT (Current Procedural Terminology) codes are aligned with the Service listings.

CPT codes are those ascribed to the services rendered for you. They also suffer a mismatch when the medical coder/biller has innocently encoded a different code for your services, especially for a service that’s more expensive than what you should be paying for. Check out this link for a complete compendium of CPT codes or visit the American Medical Association website.

4.    Make sure that the ICD (International Classification of Diseases) codes are aligned with the CPT codes.

ICD codes represent the type of disorder, or assumed disorder, that your physician has ordered the tests or medical services for. ICD codes ensure that the tests are aligned with your diagnosis, preventing fraudulent activities among insurance and medical providers, patients and staff. That is because tests and services are limited to certain diagnosis. If your bill shows ICD codes for a totally unrelated condition, then you’ve been billed wrongly.

5.    Check out the corresponding cost and make necessary deductions or additions.

Not all of us receive complete medical insurance coverage from our providers. Sometimes, only a portion of our bills will be paid by the insurance company. How do you get an estimate of your bill then? Look up the aforementioned CPT codes and find out which ones are reimbursed by Medicare. Or, check out Medicare’s pricings to find out what your insurer will be paying for.

6.    Still unsure? Contact the biller.

If you find some items that are dubious or strongly believe that you’ve been incorrectly billed, then call the number provided on the bill.

Hope you get to apply these skills, the next time you take a trip down to the hospital for a check-up. Visit our Resource Tools page for more information on medical coding and terminologies.

Do you have any questions or any great tips for our readers? Share them in the comment section below.

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