Most Common Medical Billing Errors
How common are medical billing errors?
Medical billing is extraordinarily complex, involving thousands of billing codes and multiple parties. Studies by the Medical Billing Advocates of America suggest that up to 80% of medical bills contain at least one error. Even a single incorrect code can add hundreds or thousands of dollars to your bill.
The 10 most common billing errors
1. Duplicate billing: The same service is billed twice. This is one of the most common errors and is easy to spot on an itemized bill.
2. Upcoding: The provider bills for a more expensive service or procedure than was actually performed. For example, billing for a complex office visit when only a routine checkup occurred.
3. Unbundling: Services that should be billed together as a package are billed separately at higher individual rates. Common in surgical procedures where the surgeon, anesthesiologist, and facility each submit separate claims.
4. Wrong patient information: Errors in your name, date of birth, insurance ID, or policy number can cause claims to be denied or applied to the wrong account.
5. Wrong procedure code (CPT code): A single digit error in a Current Procedural Terminology code can result in billing for a completely different — and often more expensive — procedure.
6. Wrong diagnosis code (ICD code): Similarly, an incorrect International Classification of Diseases code can cause a claim to be denied or billed incorrectly.
7. Balance billing by in-network providers: An in-network provider bills you for the difference between their billed charge and the allowed amount — which they are contractually prohibited from doing.
8. Charges for services not rendered: Items appear on the bill that you never received. This can range from medications to procedures to supplies.
9. Operating room time errors: OR time is billed in increments, and rounding errors or incorrect start/stop times can add significant charges.
10. Incorrect modifier codes: Modifier codes provide additional context about a procedure. Incorrect modifiers can result in a service being billed as more complex than it was.
How to dispute a billing error
Request an itemized bill and compare it to your medical records and EOB. Document every discrepancy in writing. Contact the billing department with your specific dispute, referencing the line items and dates of service. If the provider does not correct the error, file a complaint with your state insurance commissioner and, for Medicare/Medicaid claims, with the relevant federal agency.