How to Prevent Medical Billing ErrorsMedical bills are a major source of debt, with one study from the Consumer Financial Protection Bureau finding that medical debt is responsible for 52% of all debt listed on credit reports in America. One thing that could be making your healthcare bills even more expensive, though, are medical billing errors. Whether due to simple mistakes or intentional fraud, medical billing errors cost consumers billions of dollars every year, and are so widespread that one audit conducted by insurance companies found errors in over 90% of the hospital bills they examined. Resolving medical billing errors is tricky, which is why this article will teach you what signs you should look out for and who you can talk to if you find one. If you want to potentially save yourself thousands of dollars in costly billing mistakes, keep reading.

Common medical billing errors

In addition to errors you would find on any bill, such as duplicate charges, incorrect quantities and unremoved cancelled items or services, there are a number of errors that are specific to medical bills. To help you spot them, make sure you ask for an itemized version of your medical bill, complete with medical service codes called CPT Codes that you can look up using the Centers for Medicare & Medicaid Services website. Default patient medical bills often come with only vague descriptions of the services provided next to each charge, which don’t paint the whole picture of exactly why you owe what the bill says you owe.

Incorrect patient information: On many other bills, if a company slightly misspells your name or gets your birth date wrong, it usually isn’t a big deal, although it may show up on your credit reports. On a medical bill, though, these tiny mistakes can have huge consequences, like causing your insurance claim to get rejected or charging you for treatment you never received. You should thoroughly check your whole bill for inaccuracies, but the pieces of information that cause the most problems when incorrect are your name, sex, date of birth, insurance ID information and policy numbers.

Balance billing: Balance billing is when you still have a balance owed on your medical bill that your healthcare provider expects you to pay, even after you’ve paid your deductible, coinsurance or copayment, and your insurance company has also paid everything it’s obligated to pay. Now, balance billing is normal if you received care outside of your health coverage’s network, or sought treatment that isn’t covered by your health benefits, but if your healthcare provider has an agreement with your coverage provider, and all of the care you received is covered by your benefits, balance billing can be a mistake, and potentially illegal in some states.

Unbundling of charges: Some charges on medical bills are bundled together under a single procedural code, such as the fee for cleaning a wound and the fee for dressing a wound. However, if these charges are entered separately, becoming unbundled, it can dramatically increase the bill’s total. Unbundling errors can be pretty difficult to spot, but if you see any charges on your itemized bill that you think should be included together, you should mark them to ask about later.

Upcoding: In healthcare, there are different levels of services and procedures that correspond to different prices. Upcoding is the simple error of charging you for a higher level of care than you actually received, such as a hospital charging you for a gurney transport through the emergency room when you really just walked in on your own. Like unbundling, this can also be a difficult medical billing error to spot if you aren’t involved in healthcare, but if a charge just seems far too high for what you received, you should make a note to ask about it.

Operating room and anesthesia time: People who undergo surgery are often billed according to how long they were in the operating room or under anesthesia. Check the time you’re being billed for against your medical records to make sure they match up, and that you aren’t being billed for more time than you took.

What to do if you find medical billing errors

If you think you’ve found a medical billing error, the first thing you should do is review your insurance plan’s Explanation of Benefits or your Medicare Summary notice to make sure it’s really an error. Health coverage can be complicated, and sometimes people don’t fully understand what is and isn’t covered by their medical benefits. When you’re sure you’ve found an error, you should contact the healthcare provider as soon as you can, and be prepared to go through several people on the phone until you find someone who can help you. If you explain your situation and the healthcare provider agrees you’ve found an error, tell them you’d like to appeal your bill, and if the healthcare provider disagrees that your bill has an error, ask them to explain why the medical coding is correct. If the healthcare provider can’t give you a satisfactory explanation for why the bill is correct, it’s time to escalate.

Health coverage sources, like insurance companies and the Medicare office, want to keep your medical costs low almost as much as you do, and are usually quite eager to hear about healthcare providers with suspicious billing practices. For people with an insurance plan, your insurance company should have an anti-fraud department that can help you, but if for some reason you find them unwilling to investigate anything, you may want to file a complaint with your state’s department of insurance. You can find a list of insurance commissioners on the website for the National Associate of Insurance Commissioners. If you have Medicare, you can file a report with the Medicare office, or contact your local Senior Medicare Patrol for help, as they can investigate complaints about potential healthcare fraud. Military personnel and veterans can report their issues to Tricare.

Medical billing errors may be common, but that’s no reason to let them slide and pay more money than you have to for healthcare. For more tips on how you can cut down your bills and save money, follow our personal finance blog.