A great answer below:
- What is Medical Bill Review
- How do these errors happen?
- How long does it take?
What is a Medical Bill Review?
In simple terms, a medical bill review is a process where qualified experts review a patient’s medical bill to ensure all charges are correct and you’re not being unnecessarily overcharged for a box of tissues.
Usually, these bill reviews are used for workers’ compensation billing processes to ensure payment of bills complies with the respective state department of financial services. The professionals who conduct these reviews have strong attention to detail and a medical terminology certification. They must be knowledgeable on navigating fee schedules that change from state to state, surgical bills and catastrophic or long term cases that require proper attention.
Medical bill reviewers are experts at studying hospital bills and identifying discrepancies that could save you up to $1,300 according to this Equifax study.
They will ask for an itemized bill that line for line states each service and supply you received.
These descriptions can be very general, abbreviated, or include billing codes you and I wouldn’t understand. If the charge is inaccurate, a duplicate, or higher than usual, bill reviewers will dispute it and break down the excessive fees.
The result? An accurate, reduced medical bill.
Medical Bill reviews can be useful even for smaller bills that are tempting to pay upfront without taking a closer look. Doctors can make mistakes because they are human, and so can the billing department at hospitals.
How do these Medical Billing errors happen?
Coding Errors: Coding errors arise when the person inputting the codes entered you took a brand name drug instead of the generic pill you were given. Additionally, misclassification may occur, such as coding a simple sprained ankle as a more severe fracture.
Duplicate Charges or Inflated Quantities: It’s not uncommon to get charged for the same service multiple times. Or for a coder to accidentally input 500 instead of 50.
Unwarranted charges: Maybe when you first arrived at the hospital your doctors asked for an X-ray scan but then it turned out the patient never got one. It might still pop up on their chart and they will wrongly be charged for it.
Inaccurate Surgical Duration Billing: Surgical procedures incur costs calculated down to the minute, so make sure the times and charges are accurate.
Wrong room charges: A private room fee may appear for someone who shares a room.
Insurance issues: Challenges with health insurance coverage can emerge, due to erroneous denials or legitimate disputes between the insurer and the healthcare provider.
How long do Medical Bill Reviews take?
Turnaround times for medical bill reviews are fairly quick. Sometimes they can be done the next day or take up to 10 business days. It all depends on the type of medical bill review and the size of the bill. A medical review for one person and their 3-day ICU stay won’t take as long as a bill review of an entire department’s workers comp medical bills.
Whatever you do, don’t pay for hospital charges that your client didn’t receive!