medical billing errors

How to curb runaway medical costs

J Roberts

Here’s an article that details some of the factors behind the ever increasing costs of healthcare in the US.

Ken Alltucker

A good doctor can help guide us to a healthy lifestyle. A hip or knee replacement can ensure mobility and relief from pain. A well-run hospital can be the difference between life and death.

But physicians, medical devices and drugs cost a lot. Americans will spend $2.4 trillion on health care this year.

Hospital and doctor bills, especially for the uninsured or those without enough coverage, already can be devastating.

Without a health-care overhaul, the price tag is projected to grow, particularly as Baby Boomers swell Medicare enrollment.

Beware errors in your bill

One way for consumers to take charge of their own medical costs is by scrutinizing doctor and hospital bills, patient-advocacy groups say.

Medical Billing Advocates of America, a Virginia-based consultant, estimates that 80 percent of hospital and medical bills it reviews have some type of error. And those errors can be costly, inflating bills 17 to 49 percent more than they should be, according to Chief Operating Officer Christie Hudson.

Medical Billing Advocates has found a wide swing in pricing among hospitals and doctors nationwide.

For example, one hospital charged $15 per dose of Tylenol or $10 for use of a disposable cup. The hospital charged a patient twice for items such as gloves, swab alcohol, a warming blanket and a daily charge for an IV pump.

To monitor their costs, Hudson said customers should request a line-item bill from a doctor or hospital. She said coding errors are common. So is double billing – for example, charging for a hospital gown when it should already be covered in a hospital’s room fee.

Also, she said patients should make sure a doctor gets prior authorization from an insurance company before conducting a procedure. (more…)

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Enlisting Help for a Lower Bill

J Roberts

A great article from The New York Times Online that talks about the many challenges people face when sick, underinsured or have no insurance.  Here is a list of steps and helpful points to better manage the medical bills.

 The New York Times

MEDICAL bills have a way of piling up — especially when you’re sick or underinsured. Just ask Kirk Kupka, 48, and his wife, Susie, 53.

Mr. Kupka has multiple sclerosis. The Kupkas, who live in Lindstrom, Minn., have an annual income of $45,000 — a combination of her salary as an office manager and his disability payments.

More than 20 percent of that income goes toward health care. Their annual insurance premiums total $5,400, and then there’s the $4,000 Mr. Kupka spends on drugs, doctor’s visits and lab fees before he fulfills his policy’s deductible.

In the three years since Mr. Kupka’s disability forced him to stop working as a mental health therapist, he has accumulated $12,000 in debt.

“It’s frustrating,” he says. “We earn too much to qualify for state and county assistance, but not enough to stay ahead of the bills. I’ve thought maybe my wife and I should get divorced. But not only is it against our faith, it turns out it wouldn’t help.”

Medical debt can lead to drastic measures, forcing people to raid their 401(k)s, tap into home equity lines and, in some cases, declare bankruptcy. Surveys by the Commonwealth Fund, a nonprofit health care research foundation, found that 41 percent of adults said they were struggling to pay their health care bills in 2007, up from 34 percent in 2005. That percentage is almost surely growing.

And as Mr. Kupka’s situation illustrates, it’s not just uninsured patients who rack up large bills. Nearly two-thirds of those with debt problems, according to Commonwealth, had health insurance.

But insurance covers less and less these days, as employers continue shifting more health care costs to their employees, and as consumers resort to lower-cost plans that come with high deductibles or less generous benefits.

“People who have been faithfully paying insurance premiums for years are coming in with medical bills they can’t pay,” said Gail Cunningham, a spokeswoman for the National Foundation for Credit Counseling, an umbrella group for services that help consumers cope with debt.

But if you’re having trouble paying your medical bills, you’re not helpless, either. There are ways to reduce, or at least more effectively manage, medical debt.

CONFRONT, DON’T IGNORE Procrastinating only leads to trouble. If your bills are turned over to a collection agency, the debt goes on your credit report and will remain there for lenders, and even potential employers, to see. You may have difficulty getting a loan and, if you do get one, you’ll be charged higher rates. So take action — even if that doesn’t mean writing any checks right away.

Proceed to Step 2:

SCRUTINIZE YOUR BILLS Look over your outstanding bills and make sure the listed services actually square with the care you received. Errors are common. If terms or procedures confuse you, call the hospital’s or doctor’s billing department and ask for an explanation.

If your insurer denied one or more of your claims, resubmit the bills, advises Mark Rukavina, executive director of the Access Project (www.accessproject.org), a nonprofit group in Boston that helps consumers cope with medical debt.

“If that doesn’t work, file a formal grievance or appeal with the insurer,” Mr. Rukavina said. “Even it that fails, most states allow insured patients the right to an external review by a certified third party, often a state agency. And patients should exercise this right.”

HIRE AN EXPERT Try first to negotiate with your providers for a discount or an extended payment plan. Explain that you simply can’t pay your bills in full right now, and you need some leeway.

If this tactic doesn’t work, or you don’t have the time or energy to haggle, consider hiring a billing specialist — a professional trained to spot errors who speaks the language that medical providers understand and respond to.

Some billing experts charge only if they save you money. Others may ask for a retainer up front. Make sure you clarify the terms at the outset.

(more…)

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Medical Advocates Save Money on Medical Bills

admin

The error rate in medical bills is astoundingly high. Fully 8 out of 10 medical bills contain errors of various kinds. At Medical Cost Advocate we believe there is no better way to reduce your medical costs than to have a professional review your medical bill and then negotiate the final reviewed amount as well. We provide these services to all our negotiation customers. The below story appeared on ABC’s Good Morning America this morning, April 7th. You will find a description of some of the errors we typically encounter when reviewing your medical bills.

 

Fighting Mistakes in Muddled Medical Bills

Advocates Can Help Find Typical Medical Billing Errors

ABC News

 

Expensive mistakes on medical bills are hard for most of us to detect, because the bills are written in a mysterious language that we don’t speak.

 

But eight out of 10 medical bills have mistakes on them, according to Medical Billing Advocates of America.

 

What if you could hire somebody to translate your bills and then do battle for you?

 

Turns out, you can. And it might not even cost you anything.

 

Finding the Mistakes and Fighting Back

Artist Cynthia Kulp thought being diagnosed with breast cancer was the worst thing that could happen to her. But, then, the hospital where she received her breast cancer treatment overcharged her.

 

“To have to fight a hospital going through cancer treatment, overcharging me, they have to be the lowest of the low,” Kulp said.

 

Before her lumpectomy, she said, the hospital told her the operation would cost $5,000. Instead, she got a bill for $12,700, right in the middle of her course of chemotherapy.

 

“You can barely function, you can barely get out of bed,” she said. “How can you fight hospitals?”

 

So she hired Holly Wallack, a medical billing advocate, to help. Wallack found all kinds of errors on Kulp’s bill, such as:

 

 Mismatches. These are drugs that appeared on the medical bill, even though they weren’t listed in the medical records.

 

 Double charges.The hospital charged Kulp for two “first” hours in the recovery room. So Wallack asked, “How many ‘first’ hours do you get? Last I heard, there was only one, then he was very happy to take that charge off.”

 

 Inflated charges. The hospital billed $192 for a postoperative support bra that Wallack found on the Internet for $19 — a tenth of the cost.

 

“That was one morning in one operating room in one hospital in one little town in the country,” she said. “If you extrapolate that out to what’s going on every day, it’s mind boggling.”

  (more…)

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