Medical billing errors, including those on hospital bills, can quickly become a nightmare for both patients and their caregivers. Bills should be reviewed and processed in a timely manner to ensure they don’t contain errors. You’ll also want to examine the terms of the bill to establish a payment plan (if necessary) and submit any insurance claims and/or appeals before any deadlines are missed. The longer you wait to handle these things, the more complicated and costlier the process is likely to become.
Common Medical Billing Issues Seniors and Caregivers Experience
Identifying Payment Deadlines
Hospitals, physicians, and other providers are likely to send an account to collections if it is not paid within five to six months. While each entity follows its own guidelines with regards to how quickly it considers an account to be delinquent, most expect a bill to be paid in full unless other arrangements have been agreed to within ninety days of the date of service or within forty-five days of when the insurance company/Medicare processed the claim. Failing to pay medical bills will very likely affect a patient’s credit. In fact, unpaid hospital bills are the leading reason why people file for personal bankruptcy.
Detecting Billing Errors
Many different kinds of medical billing errors are possible, so you must have an eagle eye when you review any bills or explanation of benefits documents, whether they’re your loved one’s or your own.
Perhaps the simplest error for a layperson to find is a charge for a service that was never provided. For example, if a patient was billed for a test that was never administered, it’s important to dispute it. The fact that the clinician ordered the test and marked it on the itemized receipt (called a “superbill”) at the time of the visit is irrelevant if the lab never performed the test and recorded the results.
A patient’s medical record is the governing document when it comes to these disputes. If something is not in the records, then it shouldn’t be billed. If you ever have any questions about whether a product or service was provided, you can always request your medical files. In order to do this for a care recipient, you’ll need to have full HIPAA (Health Insurance Portability and Accountability Act) authorization or a valid health care power of attorney document.
Another common mistake on health insurance claims and billing is duplicate charges where the provider has billed for the same service more than once on the same day. While this makes sense sometimes (for example, if you have an x-ray of both your right foot and your left foot following an accident), the provider must use a special code called a modifier to explain this to Medicare or the insurance company.
Health care providers may also bill things separately when they aren’t supposed to. For example, with major procedures like surgery, a follow-up visit within ninety days of the date of the surgery should be included in the “global fee” for this service. You can, however, be charged for additional services other than the office visit itself, such as an x-ray or cast. Similarly, if you are hospitalized, the hospital shouldn’t charge separately for sheets for your bed or your hospital gown, both of which are included in the room-and-board charge.
Communicating with Insurance Companies
It is particularly critical for patients and their caregivers to be vigilant about detecting errors as soon as they receive a bill. This is because there is something known as “timely filing” in the health insurance business. Medicare regulations and the plan documents for supplemental insurance plans must indicate how long a patient or provider has to submit claims following the provision of a product or service.
Once that time has passed, Medicare (or the private insurance company) can deny any affiliated claim because it wasn’t submitted within the required timeframe. At this point, the entire bill becomes the patient’s responsibility.
Similarly, if you don’t agree with how a claim has been processed, you have a finite window to appeal Medicare’s decision or begin the dispute resolution process with a private insurer. If you miss these appeal deadlines, you’re usually out of luck.
Medical Bill Advocates Simplify Managing a Senior’s Healthcare and Finances
Even if you are good about reviewing medical paperwork, there will probably be times when you don’t agree with a provider’s bill or how a health insurance company has processed a claim. According to Medical Billing Advocates of America, up to 90 percent of hospital bills contain errors, often costing patients hundreds or thousands of dollars. If you don’t have the time or patience to handle your loved one’s bills and claims (or your own), professionals are available to assist you.
Medical bill advocates are trained to spot the errors explained above and help patients work with providers and insurers to resolve issues. An advocate can be paid to review all of a patient’s medical bills, or you can request assistance with sorting out a particular issue.
Medical billing advocates not only act as bill analysts, but they also confirm their clients are not being overcharged and ensure that insurance companies are meeting their obligations for coverage. They go over bills and insurance information with a fine-tooth comb to guarantee patients get the benefits they are paying for. These professionals even serve as middlemen between health care providers, insurers and patients to negotiate lower bills.
How to Find a Medical Bill Advocate
Free assistance with Medicare coverage, claims and appeals is available through the State Health Insurance Assistance Program (SHIP). You can contact your local Area Agency on Aging (AAA) for more information on SHIP services. There are many other community and national advocacy organizations, such as the Patient Advocate Foundation, that help patients with serious medical issues receive the treatment and medical coverage they deserve, often at no cost.
If you are dealing with a particularly complex issue or a substantial bill, it may be wise to hire a professional advocate. The best way to find one is through word-of-mouth. Patients who have had a positive experience are usually happy to share their story. Since most medical billing advocates’ work is done by telephone and email, it isn’t necessary to hire someone who lives nearby. Look for someone who has a background in health care, insurance, or related fields and provides excellent references.
An initial consultation or review of a bill is usually free, but after being hired, medical billing advocates are usually paid hourly or on contingency. With the contingency method, the advocate is paid a percentage of the total money they manage to whittle off a client’s medical bill (usually between 25 and 35 percent). In this latter case, if an advocate can’t secure a reduction in the amount owed, then the client is only required to pay the retainer fee (if any) and the costs of obtaining copies of medical records.
Before hiring, discuss which of these payment methods an advocate employs and then get the terms and conditions of their contract in writing. Working with a medical billing advocate may seem expensive, but having one on your side is crucial in cases where tens of thousands of dollars may be at stake.