Medical Billing: How to avoid an inaccurate claim.

medical billing inaccurate claim

When you suffer an injury — whether from a car wreck or a defective product, you’ll likely encounter medical billing. It’s the worst, right? If you’ve encountered medical billing and there hordes of debt collectors, more than likely you’ll agree the legalities are maddening.

Similar to a business, healthcare facilities are required to comply with state and federal regulations. Unlike businesses, though, they have to follow additional rules because they’re providing medical service. In other words, they have to balance the ethical standards of business as well as the medical standards.

Many times, hospitals inadvertently send clients to collections over medical bills incurred from a wreck. In this situation, it’s important for you to closely communicate with the medical provider and let them know their payment should be forthcoming from an eventual settlement. Additionally, it’s crucial to know basic HIPAA and other state and federal regulations that will protect you from incorrect and growing medical debt.

One of the most prominent laws you’ll run into when dealing with medical billing is the Health Insurance Portability and Accountability Act (HIPAA). It safeguards confidentiality and requires each patient be informed of their rights under HIPAA. In other words, it’s important to review all that paperwork they make you fill out.

Another law you’ll want to pay attention to concerns the relationship between medical offices and insurance companies. The included regulations range from claim filing deadlines to how billing claims are distributed. Each healthcare provider has to sign a contract regulating practices while negotiating the payment for each code the provider bills.

When a provider signs with an insurance company, they agree to a certain percentage or payment for services. And, if the amount the provider bills is over the agreed, it must be written off. What this means for you is that your provider usually can’t bill you for any amount over the negotiated rate. If they do, it’s called balance billing.

Sometimes inaccuracies occur in the healthcare industry, especially when it comes to medical billing. Mistakes, sometimes even intentional errors, take place when you’re billed for something that wasn’t performed or when reports contain inaccurate information. When this happens, the insurance company pays more.

To protect your pocketbook, and your insurance while keeping your provider in check, it’s best to check these six things before paying your medical bill:

1. Itemized details

Usually, your bill will include everything in a lump sum. To ensure you weren’t mischarged, contact your provider’s billing department and request an itemized listing of services.

2. Identifiers

Things as small as misspellings can cause your insurance claim to be rejected. Check your policy number, group number and ensure your health insurance and doctor’s information is up-to-date.

3. Each service

Line by line, check each service. Sometimes tests can be ordered and canceled after the bill was already distributed. Other times, it could simply be an administrative mistake. Whatever the case, watch for duplicates and report any false items.

4. Any irregularities

When the service item code is a bit vague, research it.  The American Medical Association provides a complete listing of all the billing codes. Other errors to look for include billing for a private room when you were in a shared room, charging for a higher level of service than received, operating room overcharges, and unbundling errors.

5. Explanation of benefits

Your EOB will be sent to you soon after the medical claim is processed by the insurance company. It shares what was covered and the amount that goes towards your deductible, copay and the remaining balance. Checking your EOB will save you from spending money you don’t need to.

6. Adjustments

If there’s nothing wrong with your bill, go ahead and pay or set up a plan with your medical provider. If you do spot an inaccuracy, though, always remember that the law is on your side and EHM is always here to help.

What are some of the experiences you’ve had with billing during a car wreck? Share your stories with us below in the comments and give us a call with any questions you may have. (580) 234-4334


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