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

could be inflating your

medical bill.

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

bill.

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

there are many people influencing medical bills.

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

upcharging.

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/.