Recent reports indicate several instances of emergency room (ER) billing mistakes. Patients are complaining that they receive bills that are inaccurate and too high. Medical billing and coding errors leave patients in the lurch and today, most are resorting to legal action to get their grievances addressed. Billing errors badly affect a healthcare provider’s credibility and can lead to heavy and irrevocable penalties.
Huffington Post reported that, according to the Medical Billing Advocates of America, nine out of 10 hospital bills have mistakes and most of them are in the hospital’s favor. Recent reports in www.lawyersandsettlements.com provide several instances of ER patients getting fleeced.
– Patients who checked their itemized bill found that it included things that they had not used.
– One patient was overcharged for a post-operative brace – it retailed at a fraction of the price that the hospital had charged.
– A surgeon was paid by the hospital for a procedure, but had also billed the patient directly – a fraudulent practice known as double billing.
– A healthy patient who went to ER for a stomach ache and was told that there was nothing wrong after a few tests, received a bill for $4,000.
Most physicians are guided by the principles of professionalism, integrity, and ethical practices, but billing errors can occur inadvertently. To maintain patient trust and ensure professional credibility, ER physicians need to be diligent about avoiding medical billing errors. Partnering with a reliable medical billing and coding company is the best way to ensure clean documentation and prevent time-consuming and costly billing errors.
Here are some of the ER billing issues that a reliable service provider can help physicians avoid:
- Mismatch between diagnosis and treatment codes: Mismatch between diagnosis and treatment codes causes upcoding and downcoding. Upcoding is reporting a higher-level service or procedure or a more complex diagnosis, than is supported by the provider’s documentation or medical necessity. On the other hand, if the physician does not provide relevant documentation details to assign a service, procedure, or diagnosis to the correct level of specificity, this will lead to downcoding.
- Balance billing: ER bills can include charges from out-of-network doctors. In most cases, patients are not aware of this until they receive the ‘surprise bill’, which is higher than what their insurance would cover. The patient is billed for the balance. Insurance verification services help physicians avoid surprise billing by verifying benefits at the outset and informing patients about what the payer will and will not cover.
- Unbundling: Unbundling occurs when multiple procedure codes that come under one treatment are listed with separate charges, instead of being listed at one, lower package rate. An ER doctor or hospital could deliberately or mistakenly unbundle codes that relate to a patient’s care leading to a much higher bill. Expert coders are knowledgeable about procedures that belong together that belong together under one code.li>
- Duplicate billing: This refers to billing a patient more than once for the same service.
The Centers for Medicare and Medicaid (CMS) requires each hospital to establish its own facility billing guidelines. These guidelines should adequately relate the intensity of hospital services to the different levels of effort represented by the codes and facilitate accurate payments. Medical billing and coding outsourcing can help ER facilities ensure adherence to these guidelines and avoid payer audits and charges of abusive or fraudulent billing.