Yes, I use a magnifying glass much just like this one when I am having difficulty reading the fine print on medical bills!
Hospital bills are often long and confusing, especially if you have been hospitalized for any length of time. You will often only receive the explanation of benefits from your insurance carrier. Call the billing department of your hospital and request your itemized bill. They may be somewhat reluctant to provide you with this information, however under HIPPA you are entitled to it and they will ultimately supply it to you.
As you review the itemized bill keep in mind the following common errors:
1. Duplicate billing: the bill includes two charges for the same service on the same day or a day apart. This also occurs with the medications. Did you actually receive the pain medication that you were charged for? Did you really have two chest x-rays in one day?
2. Number of days in the hospital: check the dates of your admission and discharge. Were you charged for the discharge day? Most hospitals will charge for the admission day, but not for the discharge day. Either method is appropriate, but not both.
3. Incorrect room charges: if a semi: private room was approved make sure you’re not being charged for a private room; Verify that the number of room charges match the number of days you were in the hospital. This number should match the number of days in number 2 above.
4. Incorrect level of care: were you moved from intensive care after a four day stay and the bill states you were in intensive care for five days? Were you moved from telemetry after 2 days and the bill states 3 days?
5. Operating: room time: it is not uncommon for hospitals to bill for more time was actually used. To determine if the time was appropriate you can compare the charge with the anesthesiologist’s records. To obtain the anesthesiology records you must request a complete copy of your medical records for your hospital stay. There may be a fee to obtain these records, but you are entitled to them under HIPPA. You may also be able to obtain just the operative anesthesia report from the hospital medical records and not the entire medical record. Hospitals have varying policies regarding medical record retrieval. Below is the top portion of an anesthesia record with a red box around the area depicting the recording of the anesthesia and operative start and end times.
6. Up-coding: hospitals often charge for a higher-cost service or medication rather than the lower cost service or drug. If the doctor orders a generic drug, the payer may be charged for a pricier brand name drug.
7. Inappropriate test billing: I have noted in a number of medical record reviews. An MRI or CT scan are performed without contrast, but are charged as a scan with contrast.
8. Gender error: an example would be a male receiving a pregnancy test or a female receiving a PSA (Prostate-Specific Antigen) test. There are rare medical instances where these tests would be appropriate for the other sex, but these are very rare and would almost never be found within a medical record.
9. Keystroke error: a computer operator accidentally hits the wrong key on a keyboard. It can cost hundreds of dollars due to an incorrect charge for a service that was not provided. If a charge looks abnormally high it is appropriate to ask the billing staff what they charge for that particular test or drug.
10. Canceled work: the physician orders a test, but then canceled it, but the charge shows up on the bill.
11. Interrupted Service: These services should be noted with a -52 or -53 after the procedure code which is a 5 digit code (xxxxx-52). Different payers pay this service differently, but usually the payment for is 50% of what the service would usually be charged. If you had a surgery or procedure that was intended to be completed, but for some reason it could not be completed be sure to ask the billing office what the normal charge for this surgery is and compare it to what is on your bill.
12. Services not ordered and not provided: verify all services charged for were actually provided
13. Duplicated services: when you look at your hospital bill do you notice many charges for the same test or medication; sometimes things like a UA are listed many times in the billing however were only done a few times during the hospital stay. If you can't remember a service or medication, ask to how many times the doctor ordered the test.
14. Much of the hospital reimbursement is based on your diagnosis. This information is not clearly visible on your medical bill. It is usually listed as a numeric code (xxx.xx or xxx.x). This code is listed under diagnosis or diagnostic related group (DRG) on your medical record. Verify that the code listed is really the diagnosis you had. Often the code represents a diagnosis that is more serous than the one you were treated for.
Hint: go to http://www.cms.gov/icd10manual/fullcode_cms/P0368.html and you will find a list of the DRG codes in the following format:
The W CC that is underlined on the first row means "with complications or comorbidities"; comorbidity means an underlying medical condition such as diabetes or heart disease that is not related to your diagnosis, but may complicate your recovery course. The second line above notes W/O CC/MCC. This indicates that the patient is without complications, comorbidities or without major complications or comorbidities. So if you were admitted to the hospital for multiple sclerosis, but did not have any complications or comorbidities 059 would be an incorrect diagnosis code which would result in a higher hospital bill. If this explanation falls short, ask the billing staff for the definition of the DRG that was noted on your medical bill or hospital record.
In summary, hospital personnel do not control the cost of treatment. They utilize a computer system to input the services, medications and supplies and medical coding can prove complicated. We know we are all human and do make errors. If you identify an error on the billing a call to the hospital billing supervisor will often correct the error and save you some healthcare dollars. If your answers are not addressed to your satisfaction you may call your insurance carrier to intervene on your behalf.
