Possible Medical Billing Errors
Why check your bill?
Medical bills can contain mistakes. Compare the itemized bill with your records and explanation of benefits (EOB), and ask for an explanation of unfamiliar charges. See CMS guidance on checking a bill.
Ten possible billing issues to check
1. Duplicate billing: The same service is billed twice. Check the date and details, since similar services can legitimately occur more than once.
2. Upcoding: The provider bills for a more expensive service or procedure than was actually performed. For example, billing for a complex office visit when only a routine checkup occurred.
3. Unbundling: Services that should be billed together as a package are billed separately at higher individual rates. Separate bills from the surgeon, anesthesiologist, and facility are not necessarily errors; ask about the relevant billing rules.
4. Wrong patient information: Errors in your name, date of birth, insurance ID, or policy number can cause claims to be denied or applied to the wrong account.
5. Wrong procedure code (CPT code): A single digit error in a Current Procedural Terminology code can result in billing for a completely different — and often more expensive — procedure.
6. Wrong diagnosis code (ICD code): Similarly, an incorrect International Classification of Diseases code can cause a claim to be denied or billed incorrectly.
7. Balance billing by in-network providers: A provider bills you for the difference between the charge and allowed amount on covered in-network care. Ask your insurer and provider to review the claim and network agreement.
8. Charges for services not rendered: Items appear on the bill that you never received. This can range from medications to procedures to supplies.
9. Operating room time errors: OR time is billed in increments, and rounding errors or incorrect start/stop times can add significant charges.
10. Incorrect modifier codes: Modifier codes provide additional context about a procedure. Incorrect modifiers can result in a service being billed as more complex than it was.
How to dispute a billing error
Request an itemized bill and compare it to your medical records and EOB. Document every discrepancy in writing. Contact the billing department with your specific dispute, referencing the line items and dates of service. If the provider does not correct the error, file a complaint with your state insurance commissioner and, for Medicare/Medicaid claims, with the relevant federal agency.