According to a University of Minnesota Professor of Health Finance and Insurance, a maximum of 40 percent of claims between hospitals and doctors (or other providers) and insurance companies (or other payers) have errors in them. Another no less disheartening fact is that 41 percent of customers have no faith that they were billed the correct amount (according to an Intuit survey conducted in 2011). Unfortunately in Ohio, there are hardly any regulations pertaining to billing.
Typical Billing and Coding Issues
Some of the billing issues that give patients a hard time are:
- Unbundling – It is a term used to refer to the listing of multiple procedure codes associated with a single treatment with separate charges. Listed as one, the rate would have been lower.
- Upcoding – It refers to modifying a code to represent a more serious treatment or diagnosis and therefore increasing the patient’s bill.
- Balanced billing – If a patient is given a bill that asks them to shell out the difference between a physician’s fees and the sum negotiated between the healthcare provider and the insurance company, it is called balance billing.
Avoid Liabilities and Penalties
The above billing and coding errors may be committed by mistake or purposely encouraged by physicians to get more money. However, if these errors are detected, the concerned physicians would have to answer for them. To avoid committing these errors unintentionally, you need up-to-date, experienced and qualified medical coding and billing staff such as you would find at an established medical billing and coding company.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.