Helping Employees Recognize (And Rectify) Common Medical Billing Errors

When employees detect medical billing errors, they often turn to their employer or human resource department for guidance on how to correct them.

Employers Serve as a Resource for Medical Billing Questions

Medical billing is detail-oriented in nature, and errors can be made easily. Mistakes happen, but your employees should not be on the financial hook for errors that were beyond their control.

When employees detect medical billing errors, they often turn to their employer or human resource department for guidance on how to correct these costly mistakes. There are many types of errors, and being familiar with them will aid you in helping employees resolve medical billing mistakes. 

It is important to keep in mind that many people will work on a patient's medical bill, including intake workers at an office front desk, doctors and nurses involved in treatment, and medical billing coders. Knowing where any given error originates will help you determine who to contact to fix the mistake.

Common Types of Medical Billing Errors

These are some typical errors you may see when reviewing employees’ medical bills:

  1. Duplicate charges are the most common type of medical billing errors, according to WebMD, and occur when a patient is billed twice for the same item or service. For example, duplicate charges may appear if the bill includes a charge for when a medication was prescribed by the doctor and another charge when the medicine was administered. Another example of a duplicate charge is if a patient is on a medication that he or she brings to the hospital; an error may occur if the hospital charges for the medication that the patient has supplied.
  2. Clerical errors are also common and can be revealed by a close reading of the bill. For example, a small item — like a toothbrush or over-the-counter medication — could be listed at a much higher price by adding a zero or misplacing a decimal point in the correct charge.
  3. Incorrect patient information includes errors that can result in the total or partial denial of a patient’s claim. This type of error can be caused by the patient or the intake worker at the medical office, but other people who work on medical bills can make this mistake as well. Pay special attention to insurance group numbers, birth dates, social security numbers, and the spelling of the full name.
  4. Unbundling of charges is a difficult error to spot, but if it is made, it can be very costly. This error is made when a charge that should be billed under one procedure has been separated into two or more charges. Typically, the only people who can determine if a charge has been improperly unbundled are certified medical bill coders.
  5. Charges for cancelled tests or procedures can also happen from time to time. If a patient thinks that he or she was billed for a test that was changed or cancelled, it is a good idea to consult other documentation that the patient may have concerning test results.
  6. Errors can also be found in operating room or anesthesia times. These services are typically billed in 15-minute increments. Patients should also check to be sure they are billed for the correct number of nights stayed in the hospital.
  7. Sometimes patients see that an insurer has declined coverage for a procedure due to a lack of medical necessity. Claims are denied for this reason when the doctor has not provided an acceptable medical reason for the service or medication. This could be resolved by having the doctor submit additional information to the insurer.
  8. Another medical billing error is balance billing when the patient has stayed in-network. A patient will be balance billed when he or she is treated out of network. In that case, the patient will be charged by the medical provider for any amount not paid by the insurance company. Balance billing should not occur if the patient was treated in-network.
  9. Finally, on rare occasions a patient’s bill may have an up-coded charge. This happens when a medical provider inflates the diagnosis and procedure in order to create a higher medical bill. This charge is illegal and fraudulent, and if the patient suspects that such a charge is present, he or she should contact the provider to rectify the situation.
     

Employees Appreciate Help with Resolving Medical Billing Errors

Whether you’re operating a startup, a small business, or a large company, your employees should feel confident turning to you (their employer) when they have questions or concerns related to their employer-sponsored health plan, including those related to billing. Being a dependable, knowledgeable resource for them in their time of need helps build quality relationships, foster trust, and promote employee loyalty.

References

Common medical billing errors and how to avoid them. (2016). MB-Guide. Retrieved from http://www.mb-guide.org/medical-billing-errors.html

Kam, K. (2016). Help for medical billing errors. WebMD. Retrieved from http://www.webmd.com/a-to-z-guides/features/help-for-medical-billing-errors-advocates#1

Plain Dealer Staff. (2012, June 24). Medical billing errors: What can go wrong? What can you do? Cleveland.com. Retrieved from http://www.cleveland.com/healthfit/index.ssf/2012/06/medical_billing_errors_what_ca.html