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MEDICAL BILLING
ERRORS COSTING YOU
MONEY
L S CODING & EDUCATION LLC
As communication between
medical coders and the
providers of healthcare grows
apart, medical billing errors
are becoming more and more
common.
On the next few pages, we
are going to outline some of
the most common errors that
UPCHARGE
S
This first error is extremely
illegal and can definitely
cause your bill to go through
the roof. Upcoding is when a
medical code is substituted for
the wrong code with a pricier
diagnosis or treatment.
Examples:
Coding a generic medication as a
name-brand.
Coding an office visit as an
inpatient stay.
SEPARATELY
BILLED ITEMS
In many instances, many
medical items are billed in a
bundle. Coding these items
separately, instead of in a
package, can inflate your bill.
Example:
A group of small tests that are
considered a part of a greater
test billed as separate tests.
* Contact a medical billing
advocacy company to help
identify if this is an issue on your
DUPLICATE
PAYMENTS
This is exactly what it
sounds like. Duplicate billing
is getting billed for the same
item multiple times – this is
one of the most common
errors. It can happen by a
nurse and a doctor
recording the same item
without checking.
Example:
The same medication billed
when prescribed and when
administered.
NOT OF MEDICAL NECESSITY
This error occurs when a
medical provider supplies the
medical coder with very little
information about your
diagnosis, causing the coder
to bill you for the wrong item.
Example:
“Lack of medical necessity” can
usually cause your insurance
company to deny your claim, and
can leave you with the entire bill.
BILLED FOR
COVERED
TREATMENT
When you receive a medical
bill for the balance after your
insurance has paid its portion
is a normal and correct
procedure. What is not normal
or correct is being billed for
procedures that should be
paid by your insurance
company under your policy.
Example:
You should not pay for medical
expenses that your insurance
company is supposed to cover.
* Contact your insurance
company to rectify the situation.
This is also one of the most common mistakes
found – your medical provider misspells your
name or incorrectly inputs your insurance ID
number. The insurance company will reject the
claim.
The fix is relatively easy but can take some time, as
INACCURATE
PATIENT
INFORMATION
DIAGNOSIS AND
TREATMENT CODES
TO DO MATCH
Diagnosis and treatment
codes not matching can
cause your insurance
company to reject the claim.
Here is an especially nasty
example:
A diagnosis medical billing
code is upcharged, but the
treatment code remains the
same. Not only is the claim
rejected, but you will have to
pay more for the item because
it has been inflated by the
CONTACT US
L S Coding and Education LLC
is unlike any other medical coding
program. Lynn Schoeler, Instructor and
President, provides an AAPC
Professional Medical Coding
Curriculum used in the Professional
Medical Coding Program. For the past
20 years, Lynn has educated coders
and healthcare professionals.
For more information on medical
coding education, please contact (866)
737-3701 or visit
http://cpc.certifiedcodertraining.com/.

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Medical : Billing Errors Costing You Money

  • 1. MEDICAL BILLING ERRORS COSTING YOU MONEY L S CODING & EDUCATION LLC
  • 2. As communication between medical coders and the providers of healthcare grows apart, medical billing errors are becoming more and more common. On the next few pages, we are going to outline some of the most common errors that
  • 3. UPCHARGE S This first error is extremely illegal and can definitely cause your bill to go through the roof. Upcoding is when a medical code is substituted for the wrong code with a pricier diagnosis or treatment. Examples: Coding a generic medication as a name-brand. Coding an office visit as an inpatient stay.
  • 4. SEPARATELY BILLED ITEMS In many instances, many medical items are billed in a bundle. Coding these items separately, instead of in a package, can inflate your bill. Example: A group of small tests that are considered a part of a greater test billed as separate tests. * Contact a medical billing advocacy company to help identify if this is an issue on your
  • 5. DUPLICATE PAYMENTS This is exactly what it sounds like. Duplicate billing is getting billed for the same item multiple times – this is one of the most common errors. It can happen by a nurse and a doctor recording the same item without checking. Example: The same medication billed when prescribed and when administered.
  • 6. NOT OF MEDICAL NECESSITY This error occurs when a medical provider supplies the medical coder with very little information about your diagnosis, causing the coder to bill you for the wrong item. Example: “Lack of medical necessity” can usually cause your insurance company to deny your claim, and can leave you with the entire bill.
  • 7. BILLED FOR COVERED TREATMENT When you receive a medical bill for the balance after your insurance has paid its portion is a normal and correct procedure. What is not normal or correct is being billed for procedures that should be paid by your insurance company under your policy. Example: You should not pay for medical expenses that your insurance company is supposed to cover. * Contact your insurance company to rectify the situation.
  • 8. This is also one of the most common mistakes found – your medical provider misspells your name or incorrectly inputs your insurance ID number. The insurance company will reject the claim. The fix is relatively easy but can take some time, as INACCURATE PATIENT INFORMATION
  • 9. DIAGNOSIS AND TREATMENT CODES TO DO MATCH Diagnosis and treatment codes not matching can cause your insurance company to reject the claim. Here is an especially nasty example: A diagnosis medical billing code is upcharged, but the treatment code remains the same. Not only is the claim rejected, but you will have to pay more for the item because it has been inflated by the
  • 10. CONTACT US L S Coding and Education LLC is unlike any other medical coding program. Lynn Schoeler, Instructor and President, provides an AAPC Professional Medical Coding Curriculum used in the Professional Medical Coding Program. For the past 20 years, Lynn has educated coders and healthcare professionals. For more information on medical coding education, please contact (866) 737-3701 or visit http://cpc.certifiedcodertraining.com/.