Best Results Organizing

Last week, Paper Doll took a week off from writing to recover from a minor medical procedure…let’s just call it a paper cut.  All is well, and I’m happy to be writing again, and the topic on my mind is hospital billing.

A few months back, we talked about organizing your medical paperwork in order to be better prepared for emergencies and other health-related issues:

• Vital Signs: Organizing For A Medical Emergency, Part 1
• Vital Signs: Gathering Information During/After A Medical Emergency–Part 2
• Vital Signs: Maintaining Your Family’s Medical Records–Part 1 (Paper)
• Vital Signs: Maintaining Your Family’s Medical Records–Part 2 (Digital)

Keeping your family’s medical records organized is an essential part of maintaining their physical health, but don’t forget about the importance of financial health.

Harvard University research indicates that approximately 62% of U.S. personal bankruptcies are caused by unaffordable medical bills. Given that, it’s vital to keep track of medical billing, particularly hospital billing, to make sure you are being charged a fair and accurate amount. In fact, some medical billing experts believe that up to 80% of all hospital and medical bills contain at least one error, underlining the importance of vigilance in scrutinizing your medical billing paperwork.

So, what kinds of errors should you watch for?

Double-charging:  Duplicate billing is a common hospital billing error. When you review your itemized bill, check dates and codes carefully to make sure you haven’t been charged twice (or more) for the same service, medication, procedure or supplies.

Where and When:  Common mistakes on medical bills include mis-charging for room types (i.e., billing for a private room when when you shared a semi-private room, or billing for an ICU bed when you were given a regular private room) and mis-charging for dates of hospitalization. Check your bill to make sure you haven’t been charged for dates after your release.

Bills for tests or procedures never done:  A doctor might order but later cancel a procedure. Months ago, Paper Doll found herself facing an MRI. Although I’d never actually teased anyone for having been too claustrophobic to undergo an MRI, I’d watched the test on numerous nighttime dramas over the years and been secretly flummoxed by how anyone could be so freaked out when there was SO MUCH SPACE. Then, I found myself face to face (or shall I say, nose to ceiling) with an MRI and lasted all of 6 seconds before screaming to be released. In some cases, after all the effort is made to prepare for and start a procedure, nobody notes a change in the record indicating that the patient was a complete scaredy-cat and the procedure eventually canceled.

In other incidences, services aren’t canceled so much as never rendered. Physicians may order a treatment or test that becomes unnecessary, but no notation makes it into the record to say that the work wasn’t done, leading to inaccurate billing.

Obvious, ridiculous errors:  If your husband’s medical bill includes obstetrics-related charges, your first thought shouldn’t be that he’s been hiding a really big secret from you. The likely culprit? A simply typo or keystroke error by a data-input technician. One missed or transposed digit can be the difference between a bill for hundreds of dollars and hundreds of thousands of dollars.

Operating With a Bum Ticker (a bad clock, that is):  If your hospital bill includes operating room time, check it closely to make sure you haven’t been billed for longer than your procedure took place.  There’s no need to nickel-and-dime over minutes, but if your procedure took less than an hour and you are being billed for three hours of operating room time, it’s worth a second look. Experts suggest checking the hospital’s billing time against the records of the anesthesiologist to get a more accurate view.

Up, Up and Away: Upcoding is the name for when hospitals charge for a more costly version of a lower-cost product or service. This is harder to detect after the fact; for example, unless you’re reading the markings on your meds with a monocle, you might not be able to tell that you got a generic drug but were charged for a brand-name.

And, of course, we’ve heard of upcharging ridiculous amounts for items coded to sound high-tech and more costly, like over $100 for a box of tissues retitled as mucous removal devices. But before we get too up in arms, the vast majority of these mistakes are, indeed, mistakes–merely clerical errors and not the result of any evil master plan on the part of the medical establishment. As with any billing error, it’s up to the consumer to catch mistakes and begin the process of rectifying the situation. Some steps in that direction:

1)  Keep a log. Sure, if you’re in the hospital, the last thing you want to do is stay awake, let alone keep track of what may seem like minor issues. However, if it’s at all possible, let your loved ones help you keep track of what procedures or tests you had done (or what drugs you received), and when, while hospitalized.

2)  Show up for mail call.  Open your medical bills (no matter how scary you might fear them to be), arrange them in chronological order (by date of procedure) and review the accuracy against your own records (including your hospital log). Ignoring billing (whether correct or incorrect) leads to trouble; hospitals will eventually have to turn over unpaid accounts to collections agencies and will likely report the accounts to the major credit reporting agencies (Experian, Equifax and Transunion), adversely impacting your FICO score, as we discussed recently.

3)  Request an itemized bill (and not merely a summary bill) from the hospital showing not merely codes but full descriptions of all billed items.

4)  Know about codes. For example, ICD codes like ICD-9 and ICD-10 (i.e., diagnostic codes) identify what’s wrong with you, while CPT (procedure) codes specify what treatment (medical, surgical, etc.) you received.  Sometimes, a typo can make the diagnosis and procedure fail to match (imagine a appendectomy [procedure] performed because of a broken toe [diagnosis]), which causes the insurance company to fail to cover a medically necessary procedure.

Forewarned is forearmed; the more info you have, the easier it will be to catch errors. If you or your family are facing a lot of complex billing issues, you might want to subscribe to a medical billing code site like Find A Code or Doc Office Rx to translate the gobbledegook into meaningful medical terms. You may also be able to access the meaning of some codes via the U.S. Department of Health & Human Service’s Centers for Medicare and Medicaid’s diagnosis and procedure code database, and the World Health Organization maintains an online, public database of ICD-10 codes.

5)  Notify the hospital billing department of any errors you find, in writing, by certified mail. Copy your insurance company on these letters, as even if you are not paying out of pocket for the billing errors, undetected mistakes end up costing insurance companies (and therefore, all of us), in the end.

6)  Consider hiring the services of a medical billing advocate if, once all efforts on your part have been exhausted, the hospital refuses to correct errors of excessive value.

Stay healthy (physically and financially), and we’ll meet again next week.