Coding Errors

When do I look for medical billing errors?

If you are facing a surprisingly large hospital bill, you should check for medical billing errors. Medical billing errors are surprisingly common, with some studies suggesting nearly 13% of all billed medical costs are erroneous.

What do I need to identify medical billing errors?

Start by obtaining an itemized hospital bill, listing every line item and including all billing codes. If you do not have online access to your Electronic Medical Record, call the hospital and request a copy.

You will be looking for three types of medical billing errors:

  1. Charges for Services Not Provided: Hospital bills sometimes include line item charges for services that were not actually provided. Compare your bill line items against your electronic medical record.
  2. Unbundling: Unbundling is a type of hidden charge in which a procedure or test covered by a single code is also billed a 2nd time with individual codes representing part of the procedure or test, resulting in a duplicate charge.
  3. Upcoding: Hospitals sometimes bill for a similar service that is more complex and costly than the service actually provided.

There are free online resources to help understand billing codes and identify potential medical billing errors.

How do I get medical billing errors resolved?

If you have identified errors in your hospital bills, call the hospital and ask to speak to someone in the billing department. Talk through your bill line-by-line and explain why you believe there are errors.

What resources can help me identify and resolve hospital billing errors?

There are multiple helpful online resources to help understand hospital bills and identify potential medical billing errors.

  • Healthcare Blue Book helps explains what the billing codes in your itemized hospital bill represent
  • Find-A-Code offers a free trial under which you can use the NCCI Edits Validator to enter the codes on your bill and detect code pairs that indicate unbundling

The American College of Emergency Physicians has a breakdown of what should constitute different coding levels for medical emergencies.

Tips for dealing with medical billing errors

  • Analyze your medical bill’s line items starting with the biggest charges. Researching billing codes can be time consuming and confusing – starting with the biggest charges gives you the best chance of identifying meaningful savings.
  • Be persistent. The first person you speak at the hospital may not have authority to resolve the billing errors.
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