Imagine you were hospitalized and the administrative staff member who translates the treatment provided into codes incorrectly interprets the care given and chooses the wrong code! For instance, you received emergency care for an attack of asthma and the clerk wrong entered the code for a simple allergy. It could also happen that the wrong code is entered due to a simple typographical error. The result would be the same – an error in your medical bill which could result in claim denial – something which may not be easy to correct. Billing errors are also costly for providers to correct.
A 2012 study by American Medical Association (AMA) showed that private health insurance paid the wrong amount for one out of 10 bills, though the error rates of paid medical claims by private health insurers decreased from 19.3 percent in 2011 to 9.5 percent in 2012. When health insurance exchanges go live in 2014, healthcare facilities will compete for up to 24 million newly insured patients, according to The Advisory Board Company. This could, in turn, increase the incidence of medical billing errors.
So, how can you prevent such mistakes? The following are some important tips offered by billing experts:
- Make sure that you healthcare provider keeps accurate, up-to-date information on you – the spelling of your name, your correct date of birth, address and so on. Try to get your friend or family member to verify these details when you are being treated.
- When enrolling in an insurance plan, know your coverage including your deductibles and co-pays. Some insurance companies cover 70 percent for an out-of-network visit and you would have to pay the rest. Not having such information would make it difficult for you detect errors.
- Keep records to help you track the medical services you have received and what you have paid for them, as the bills may come months later.
- You must not lose the ‘Explanation of Benefits (EOB)’ form received from your insurer. This document explains what is paid for and what isn’t. If your claim gets rejected, the EOB will help you to find the reasons for the denial.
- Don’t rush out to pay the bill on receiving it. Instead, read it thoroughly and ensure that it contains the items that you or your insurers haven’t already paid for. Check the medical bill against your EOB and make sure that there are no errors.
Such billing errors may be minimal in physician practices that rely on professional medical billing services who are specialized in this area. An established medical billing company provides medical offices with a full suite of services from patient scheduling and patient enrollment to insurance enrollment, verification and authorizations to medical coding and audits, EOB analysis, and more. Comprehensive services, error-free solutions and the right medical billing company help keep all involved happy – the patient, the physician and insurer.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.