4 Common Medical Billing Errors and How to Fix Them

According to Healthcare Business & Technology, about 80 percent of medical bills include errors. This isn’t surprising because as many as 250 people can be involved in generating a single bill. Depending on the type of service, it could involve a diagnostic facility, testing lab, provider, billing staff, etc. These errors, whether human or via technology, can result in you being charged extra or (in some cases) a covered service not being paid at all.

If you’re not sure how to recognize when you’re being billed incorrectly, you’re not alone. We’re here to show you which common errors to look for and what you can do to get them fixed.

• Error #1: Upcoding
• Error #2: Duplicate Billing
• Error #3: Canceled Procedures
• Error #4: Identification Inaccuracies

• Step #1: Compare Documentation
• Step #2: Verify With Your Provider
• Step #3: Contact Your Health Insurance

The Most Common Errors

Error #1: Upcoding

Every procedure, office appointment, and test receives its own Current Procedural Terminology (CPT) code that is set by the American Medical Association (AMA). Upcoding occurs when your provider uses the wrong billing code and increases the amount of money the practice receives.

Example: You were sedated for a procedure, but were billed for a more complex anesthesia service that you did not receive.

Most likely this is a clerical error from when the CPT code is being entered, but you should remain diligent in checking to see that your Explanation of Benefits (EOB) statement and bill have the correct services that you received listed.

Error #2: Duplicate Billing

This is when you get billed twice for the same office visit, test, medication or procedure. With multiple health care personnel handling your chart, it’s easy for multiple instances of a test or medication to be noted twice.

Example: You received medication in the hospital that was noted by both the nurse and the doctor; the billing staff sees both instances and bills you twice for it.

Error #3: Canceled Procedures

Be on the lookout for listed service or procedure charges you never received due to a rescheduling or cancellation. These procedures have already been entered into the system and associated with your patient account, but might not have been removed in the event of a cancellation.

Example: You had blood work scheduled at a future date, but it was canceled after a different test gave new information.

Error #4: Identification Inaccuracies

Unclear handwriting is one of the main causes of incorrect information. Even if you’ve correctly filled out all the forms at your doctor’s office or in the hospital, they may be accidentally misread or miswritten by someone handling them. These errors could include:

• Wrong social security number
• Wrong date of birth
• Incorrect policy number
• Missing group number

Example: An office staff member incorrectly inputs your policy number, so you’re billed as if you don’t have your insurance coverage.

Now that you know what kinds of errors can be on your health care bills, we’re giving you some easy-to-follow tips for how to handle them. Make sure you don’t immediately pay a bill if you have questions about it. Instead, do the following:

How To Address Errors

Step #1: Compare Documentation

You should get two items for each office visit, test or procedure: a bill and an explanation of benefits (EOB). The medical bill is sent by your provider, but your EOB is a summary provided by your insurance.

Compare both documents to make sure the charges and dates of service match. For example, if your EOB does not include something on your medical bill, it’s a good assumption that your provider billed you directly and did not submit the claim to your insurance. Also check to see if any past recent payments you’ve made to that provider are included.

Step #2: Verify With Your Provider

Remember, even the smallest mistake can mess up the whole process. If you believe it was simply a clerical error, contact your provider to discuss. This could result in the confirmation of an error or an explanation of why the information is correct. If the item in question is in regards to a different facility or lab, then you would have to contact them directly to discuss the discrepancy.

Step #3: Contact Your Health Insurance

If your conversations in the previous step do not resolve your concerns, then it’s time to call up your insurance company. Be prepared with details, and don’t wait weeks to contact them, because issues like this can take time to resolve. If you don’t get any answers right way, put your request in writing and keep your communication documented.

You never want to pay more than you have to, especially when it comes to health care costs. We’re here to help if you have a problem with your bill. You can call the number on the back of your insurance ID card or visit one of our walk-in centers to talk to someone in person.