Patient Complaints put Hospital Medical Billing Practices in the Spotlight

by | Last updated Jul 4, 2023 | Published on Jun 5, 2017 | Medical Billing

Hospital Medical Billing
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Revenue cycle management experts in medical billing companies are well aware of risks of billing errors. Mistakes can cost the healthcare provider a lot of money and headache in addition to destroying their relationship with their patients. Outsourcing medical billing and coding to a reliable service provider can reduce such risks to a great extent. However, recent reports indicate that errors are rife in hospital billing and that patient complaints have put many top providers in the spotlight for their questionable billing practices. One hospital paid up to $80,000 to disgruntled patients.

Healthcare Finance recently reported on four hospital systems in Colorado that were called upon to explain their billing practices by a news channel to reply to on-air questions based on patients’ complaints. Though the providers declined the invitation, they said they are reviewing their billing practices and continually taking steps to improve them.

A recent report traced consumer complaints. One patient reported being charged $2,300 for putting two drops of deadener in the eyes. Many patients said they were overbilled for MRIs by the medical center they went to as they found that the cost of the same MRI was lower in other facilities in the vicinity. Inflated billing was also reported for blood work.

According to a 2016 Kaiser Health News report, patient advocates put the medical bill error rate at around 75 or 80 percent. The most common medical billing and coding errors include:

  • Errors in insurance or patient information
  • Duplicate charges for the same service
  • Billing for cancelled treatments and services not rendered
  • Inappropriate E/M coding
  • Lack of proper documentation to support medical necessity
  • Upcoding or unbundling
  • Billing for incorrect quantities of medication

Revenue cycle management (RCM) experts say that patients don’t understand the intricacies of their coverage. Medical billing is a complex process governed by federal law, state regulations, industry standards and insurance regulations and contracting. Regulatory complexity can result in different costs for patients in government programs, depending on the event. High deductible plans place a greater financial burden on patients, many of whom are not aware of this change and its impact on their coverage.

Outsourcing medical billing is a practical strategy to avoid medical billing errors including those that can lead to medical debt. Technology plays a key role in RCM. A reliable medical billing and coding service provider would be well-equipped with robust technology as well as a team of expert team to ensure error-free procedures in keeping with the latest industry regulations. With experts handling the RCM process, providers can focus on patient care. Reliable companies can provide medical billing solutions on any type of software.

On their part, medical practices and hospitals should take proactive measures to understand patient billing concerns and mitigate their confusion. Patient eligibility verification prior to the provision of services is critical as it will help patients understand their coverage and also minimize claim rejection and delayed payments. Providers should also focus on providing customized billing solutions for their diverse population base.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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