Medical Billing

# Medical Billing Errors Patient Rights: Billing Errors Prevention and Detection

- May 28, 2024
- Posted by Kristen Edwards

12 Aug

Life is unpredictable, you never know when you will come across a sudden illness or physical damage that will leave you in a puddle of debt. In fact, according to Forbes, in 2021, 50% of Americans carried a medical debt, and 57% owed a minimum of $1000. The percentage now has risen to 58% as per Consumer Financial Protection Bureau.

Honestly, nobody would like to be welcomed home with a beefy medical bill after a long sickness. Therefore, it is crucial for you to tackle the situation smartly and as quickly as possible. Delaying such matters will cause nothing but stress. To deal with that, you must have an understanding of medical billing errors patient rights.

Below we have detailed some common medical billing errors that cost the patients their lifetime savings.

## How much do Medical Billing Errors cost consumers?

According to CFB estimates for the year 2022, medical billing errors in the United States are trapping consumers in a ‘doom loop’, costing them $88 Billion every year. Resolving those errors can be challenging, tricky, and sometimes even lengthy if it’s at large-scale healthcare groups. Therefore, it is important to ensure that you as a healthcare system prevent errors on the medical bills before sending them to patients.

source:coronishealth.com

## Common Errors in Medical Billing

Even small errors like inaccurate quantities of services, duplicate charges, or already canceled items in the bill can cost the patients a fortune.

Default patients often have vague information about the received services on their medical bills. Such patients ask for a detailed itemized list of their received services with correct medical service codes to cross-check them on the Centers of Medicare & Medicaid Services website.

People with a thorough knowledge of medical billing errors patient rights can only act smartly and prevent financial damage.

Here are some common medical billing errors that, fortunately, are preventable if detected at the right time.

### 1. Incorrect Information

There is no such small task in medical billing. Every step is important and must be done accurately. A misspelled name or an incorrect date of birth can have major consequences. While they don’t sound like a big issue, imagine when a medical bill is prepared with a name typed incorrectly and mistakenly delivered to your doorstep. Wouldn’t it give you a mini heart attack? Therefore, always ensure that you cross-check the patient’s data at all steps. Also, such mistakes will make it challenging to deal with the insurance companies.

### 2. Balance Billing

If you have been to a facility for a medical checkup, you must have heard of this term. Balance billing, also known as surprise billing, is the remaining balance the patient has to pay after their insurance company pays for the consumed services. Surprise billing is common if you have received services outside your out-of-network healthcare provider. All healthcare providers who don’t have a contract with your insurance company come under out-of-network providers. That said, sometimes, due to medical billing errors, the same problem can happen with your registered healthcare providers.

### 3. Upcoding

Upcoding is a different type of medical error usually done by an inexperienced person or intentionally to charge the patient more. In this type of billing error, a bill is prepared for an expensive healthcare service instead of the one consumed by the patient which is then sent to the payer or the insurance company for reimbursement.

You can take it as you walk into a facility for a consultation, but the care provider charges you for gurney transport. It is more like fraudulent medical billing.

### 4. Unbundling

Unbundling is another medical billing error in which the patient is charged separately for a medical treatment that already comes under one procedural code. For instance, if you walked into a facility for a deep-cut treatment and got it cleaned and stitched. The healthcare provider must charge all of them under a single code. The error occurs when all those services are being billed separately. When this happens, your medical bill shoots to the sky dramatically.

### 5. Bills for surgeries

Often times medical billing errors occur due to the wrong calculation of operating room and anesthesia time during surgeries. It must be calculated based on how long the patient was in the operating room or under anesthesia. When wrong information is inputted into the system, it generates an incorrect medical bill.

source:moretechinstitute.edu

## Medical billing errors patient rights

One must know his/her rights as a patient to prevent any kind of financial damage due to medical billing errors. Below is a guide for patients to catch errors in medical billing.

### 1. Check bills for accuracy

While it feels like a full-time detective job, it’s necessary to cross-check bills during check-out as you can get caught between your service provider and the insurance company. Therefore, check your bill closely to see if all the incurred services are correct and that you have received them all. Make sure the bill has your name and other information correct. If you find difficulty understanding anything, ask the provider for an explanation in layman’s terms.

### 2. No Surprise Act Protection

Under the No Surprise Act, if you receive any treatment starting from Jan 1, 2022, you should not receive unexpected medical bills for emergency treatments from a healthcare service provider that you didn’t know was outside your healthcare network.

### 3. Financial Assistance Program

If you are unable to afford a medical care service, certain non-profit facilities are required by law to educate and offer you financial assistance programs. However, you must contact your state’s local services to check if help is available.

### Conclusion

Whether it’s a patient or a healthcare provider, medical billing is an essential step in any practice for everyone. Both, the patient and the service provider suffer if the medical bills are not submitted accurately. Therefore, as a medical billing service provider, ensure that you submit accurate information to the patients and their insurance providers to avoid any financial damage. And as a patient, it is your responsibility to cross-check the bills then and there to prevent any errors.

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