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Understanding Medical Billing Errors and Patient Rights

Understanding Medical Billing Errors and Patient Rights

The Consumer Financial Protection Bureau once estimated that 52% of all debt listed on credit reports in America is a result of medical bills. And when a consumer has a bad charge on their credit card bill from a medical billing error, that is a black mark on the practice they have visited.

If you are like most Americans, you know that feeling. When you get a surprise bill for hundreds, if not thousands, of dollars — well, the reaction isn’t one that you can transcribe for some people. Because there would be a lot of expletives involved. No one likes that type of surprise!

The Cost of Medical Billing Errors

Medical billing errors can cost consumers billions of dollars every year, and resolving those billing errors can be a tricky, sometimes lengthy process especially at larger-scale practices and healthcare groups. That’s why making sure you can prevent errors on the bills you send to patients is of utmost important to any practice.

Common Errors

There can be things as simple as duplicate charges or incorrect quantities of services, or cancelled items that were not removed from the bill. Default patient medical bills often have vague descriptions of what services were provided, so patients will sometimes ask for an itemized version of the bill with complete medical service codes that can be looked up on the Centers of Medicare & Medicaid Services website.

Incorrect Information

There’s plenty of bills that can be sent to a person in their life that may have a wrong name, or a wrong birthday on it. Sometimes, that isn’t a big deal — think of the number of times that you may have gotten a mailing with your name spelled incorrectly, or a piece of mail was sent to your address by mistake with a different person’s name on it? But with medical billing, there is no such thing as a “small mistake” with spelling of a person’s name. Those mistakes can have huge consequences when dealing with insurance companies.

Surprise Balances

You may think you’ve paid your bill in the office after a doctor’s appointment, but there is also something called balance billing, which is a balanced owed on a bill that a healthcare provider will expect a person to pay even after the deductible or co-payment. Balance billing is normal if you had treatment outside your healthcare network, but that doesn’t mean that mistakes cannot sometimes happen.


Upcoding is simply known as charging you for a higher level of care than you actually received, such as a hospital charging for a gurney transport when really what happened is you walked into the ER under your own power. Upcoding is a difficult error to spot for those not trained in medical billing.


Some medical bill charges are bundled under a single procedural code. One example of this is when you have a deep cut that needs to be cleaned, then have stitches, before the wound is properly dressed. But sometimes those charges are entered separately, and when that happens in some instances it can dramatically increase the bill’s total.

Operating Room Time and Anesthesia Time

It’s common for bills for surgeries to be according to how long people were in the operating room or under anesthesia. And sometimes that number can be inputted incorrectly on the bill.

The types of mistakes listed above can be a nightmare for a provider. Especially if the mistake can track back to them with a mistake made in the practice’s office. The problems with medical billing errors aren’t just clerical — they can negatively impact a patient’s care, too. Incomplete or poor documentation on the part of the provider can contribute to the large number of medical bills appearing in practices across the country.

Here are some simple solutions that could go a long way:

  • Avoid non-specific diagnostic codes and incorrect modifiers.
  • Ensure all codes are accurate and do not add additional codes, aka upcoding.
  • Before submitted a medical bill to a healthcare network, triple-check all information to ensure there are no errors in compiling the bill. If a company rejects a claim, often times it’s because they found an error.
  • Make sure you are up to date on any medical billing changes. Regulations and laws concerning medical billing can change frequently, so making sure you stay on top of changes to avoid inadvertently incorrect bills is paramount.

Medical billing is an integral part to any practice, but it’s essential to ensure the bills you submit are accurate, especially given its critical role in medical billing. At Med USA, we have decades of experience in medical billing and many other departments that can take the workload off your practice and allow you to focus on what’s important: Giving the best possible medical care to your patients.

Want to Be Sure Your Practice’s Billing is in Order?

Schedule a free billing audit with a Med USA expert today!

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