If you are a medical provider, you should know your patient’s rights when it comes to medical billing. In 2010, Medicare paid $6.7 billion in claims that were not appropriately coded or billed. The proper billing of services is vital for two reasons – patients get billed for the services provided to them, and your doctor’s office gets paid. Incorrect medical billing can cause problems for your practice, including making your practice look incompetent.
Medical Billing Errors and Patient Rights
If you want to prevent medical billing errors, it’s important to pay attention to details. Double-check your patients’ personal information, check for erroneous codes, and be careful with insurance details.
This article will go over some of the most common medical billing errors and provide solutions for preventing them. These mistakes are caused by a variety of different factors. By paying attention to details, checking for inconsistencies in your records, and using the correct codes, you can prevent many costly errors and improve your medical billing.
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Unbundling
Unbundling in medical billing may occur due to a mix-up in the coding of a procedure. It is when multiple CPT codes are used for different parts of a single procedure. This may be the result of a miscommunication or a deliberate attempt to increase the payment for a procedure. Unbundling can be a problem if the billing service provider fails to review its records carefully to identify all instances of unbundling.
Using the most comprehensive code for a procedure is the best way to report this error. HCPCS, also known as the Healthcare Common Procedure Coding System, is a comprehensive coding system used to describe medical services. Using a single HCPCS/CPT code to report a group of procedures is known as unbundling.
However, providers should not bill separate CPT codes for the same procedure, unless the services were performed separately. This is known as “double billing/dipping”, and it is considered unethical for a health care provider to bill patients separately for procedures that are performed together.
While unbundling medical billing codes can be difficult to detect, you can readily recognize it from the fragmented billing and coding of each component of a service where one code was appropriate. As a patient, you have the right to demand a copy of your medical bills.
In many cases, unbundling errors are difficult to identify without the help of a whistleblower. Unbundling is also difficult to detect because people receiving healthcare are not necessarily familiar with the complex terminology used for medical billing and coding.
A recent False Claims Act lawsuit against Duke University resulted in the university paying $1 million in settlement for charges of false claims and wrongful billing. It was found that Duke had improperly billed for anesthesia and cardiac services by unbundling the claims. These types of unethical billing practices can expose providers to criminal and civil liability.
In addition to medical billing errors, patients should be aware of double billing, which occurs when a bill is submitted multiple times. It is not uncommon for providers to double bill, and patients should, therefore, check their bills carefully for possible medical billing errors or fraudulent practices.
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Upcoding
If you believe that you have been a victim of upcoding, you may want to learn more about your legal rights and options. While upcoding is often the result of fraudulent billing, it can also be the result of clerical error or misunderstanding. As a result, it can be difficult to prove a healthcare provider’s guilt, even if the case is minor or insignificant.
Fraudulent upcoding costs health payers a lot of money, which they then pass on to consumers. Health insurance companies often raise premiums to cover the increased costs. The process can also result in duplication of orders for medications, lab work, and hospital room fees.
For example, a doctor may order a five-minute nurse consultation, but bill for a 45-minute doctor examination. This would constitute upcoding and a violation of patient rights. If you suspect you have been a victim of upcoding, call the customer service line and report the problem.
Similarly, report any fraudulent practices to the state Medicaid office. Action will be taken under the False Claims Act to lay severe penalties against healthcare providers, as well as significant fines. However, you can help ensure that upcoding is a rare occurrence by taking the time to review your billing processes.
On the other side of the fence, outsourcing services or hiring experienced professionals can help you ensure that your medical billing is accurate. Upcoding can also happen due to fragmentation and unbundling. While Medicare and Medicaid have lower reimbursement rates for the same procedures, providers are often unbundled and charged separately.
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Incorrect Use of Modifiers
Using the wrong modifiers on claims is a serious billing error that can cause non-compliance, fraud, and even payment issues. When a modifier is used incorrectly, it can affect the payment for the service or procedure.
Additionally, the incorrect placement of modifiers can lead to medical documentation requests. It is important to make sure that the documentation contains the appropriate information and is comprehensive enough to adequately describe the service or procedure.
When using modifiers in medical billing, you should keep in mind that not all payers follow the same standards. It is vital to know the modifier policy for each payer to ensure proper claims adjudication. The correct use of modifiers in claims will also help reduce the risk of NCCI edits. Modifiers should always be placed in the first modifier position. By following these guidelines, you can be assured of the proper adjudication of your claims.
Correctly using modifiers is critical for accurate medical billing. If you are not careful with modifiers, you will be accused of billing for services you did not provide. Incorrect use of modifiers can also lead to denied claims and revenue leakage.
As a provider, it is imperative that you follow all the guidelines and the rules for using modifiers. This will ensure that you avoid the potential financial impact of incorrect modifier use.
Misuse of modifiers can be a major contributor to erroneous medical bills. If a diagnosis code is used improperly, it can cause the services to be rendered incorrectly. For example, a patient may receive an MRI on the wrong knee due to a missing two-digit modifier.
Incorrect use of modifiers may lead to payment delays. If a patient is not provided with the correct service, the provider could be held liable for the cost of the procedure.
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Patients’ Right to a Patient Advocate
A patient advocate is a valuable resource to patients and their families. They will be able to negotiate with the insurance company, provider, and hospital on your behalf to get your bills corrected. He or she can also help you dispute your bills with your insurance company.
These professionals will help you obtain a better understanding of your medical bills, including upcoding, unbundling, and balance billing. In the event that you are not sure about what to do, a patient’s advocate will come to the rescue by helping you make an informed decision.
A patient advocate will listen to your concerns and complaints, help you understand medical bills and your hospital’s policies, and navigate the medical billing process. They will also help you find local services and explain your insurance coverage. They will typically work with your medical team to resolve any issues.
Patients’ right to a patient advocate is protected under federal and state law. They have the right to receive a copy of their bills and will be able to contact their advocates for help with any issues that arise.
Generally speaking, patients have the right to receive a full explanation of their bill, an explanation of why they were transferred from one hospital to another, and a mechanism to keep them informed about their ongoing health care needs.
In addition, they have the right to request an interpreter if necessary, or to have someone with them who can translate the bill for them. However, it’s important to note that these rights can sometimes conflict with legal requirements.
The patient’s right to a patient advocate is a powerful tool that can help you fight for your rights when it comes to healthcare billing. These rights are part of the Patient’s Bill of Rights and can help protect you in many ways.
See Also: Improving Pain Management Services For Patients
Conclusion
Incorrect medical bills affect everyone – providers, payers, and patients. Billing errors delay payment, affect cash flow, and result in overcharges.
Although most extra costs are paid by insurance companies, patients can be directly affected by an inaccurate bill. By working together to address these issues, providers and payers can improve the quality of healthcare and help prevent medical billing errors.
In addition to advocating for better healthcare and supporting innovative technologies, patients can also examine their medical bills for errors and speak for their patient rights. Even though mistakes are inevitable, medical billing professionals must take steps to avoid them and protect patients.
If you are looking for a tailored billing and collection service for your practice, Precision Hub offers complete solutions for medical billing, coding, and claims management. We help you to deliver patient-centric care by avoiding these headaches and focusing on growing your practice.
For more information, please get in touch with Precision Hub Manager today!
