Ask the Doctor

This month our question comes from R.B. of Texas . He asks, “What is the cause of all the errors that you find and correct?” Answer from Dr. Marrs,

There are many sources for the errors that occur in medical billing. Some of the more common ones are:

Simple human error. For example, someone might make a mistake while keying information into the provider or insurer’s computer system, such as entering a quantity of 10 instead of 1.

Duplicate billing. Billing that has been previously considered for payment and is paid a second time in error.

Bill for supplies and/or services that were never received or performed. Often, items or services appear on a bill, but there is no substantiating documentation that assures the patient actually received the item, or that the service was ever performed.

Patient Not Covered. When employees, their spouses or dependants are removed from the insurance policy, they are not always removed from the insurer’s system, and the insurance may continue to pay for that patient’s care even though they are no longer covered. This error affects mainly self-insured corporations.

Unbundling. We usually see unbundling on hospital bills, and it’s one of the most rampant areas of overbilling. When a service is unbundled, it means the patient is charged separately for services and items that were also billed (or “bundled”) as part of the overall charge for the procedure they had.

These are only a few of many common errors. It’s important to have a qualified advocate perform a full and comprehensive review to ensure that errors of all kinds are discovered and recovery of overpayments can be secured.