Medical Bill Errors: What to Look For

Medical Billing Errors Are Incredibly Common

Research from medical billing advocacy organizations consistently finds that a majority of medical bills contain at least one error. These errors overwhelmingly favor the provider, meaning they result in you being overcharged rather than undercharged. Understanding the most common types of errors can save you hundreds or thousands of dollars.

Duplicate Charges

Duplicate charges occur when the same service, supply, or medication appears on your bill more than once. This can happen when a charge is entered during registration and again during the procedure, when nursing and pharmacy systems both generate a charge for the same medication, or when a charge from a prior visit is accidentally carried forward. To catch duplicates, sort your itemized bill by date and CPT code and look for identical line items.

Upcoding

Upcoding is when a provider bills for a more expensive service than what was actually provided. For example, a standard office visit (CPT 99213) billed as a comprehensive visit (CPT 99215) can nearly double the physician charge. ER visits are particularly prone to upcoding because they use a five-level severity system and many facilities default to the highest level. Compare your bill to your medical records to verify the complexity matches what actually occurred.

Unbundling

Unbundling occurs when a provider breaks apart a group of services that should be billed under a single bundled code and instead bills each component separately at a higher total price. For example, a comprehensive metabolic panel should be billed as a single test (CPT 80053) rather than as 14 separate blood chemistry tests. If you see many individual lab charges, research whether they should be bundled.

Incorrect Patient Information

Simple data entry errors can cause significant billing problems. A wrong insurance ID number can result in a claim denial and a full bill sent to you. An incorrect diagnosis code can make a covered service appear uncovered. Even a misspelled name can create claim processing delays. Verify that your name, date of birth, insurance information, and diagnosis codes are all correct.

Charges for Services Not Received

It sounds outrageous, but being billed for services you never received is more common than you might think. This includes medications that were prescribed but not administered, supplies that were opened but not used on you, procedures that were discussed but not performed, and specialist consultations that never occurred. Cross-reference your bill against your discharge summary and medical records.

Operating Room and Recovery Room Overcharges

Surgical patients should pay particular attention to operating room time and recovery room charges. OR time is often billed in 15-minute increments, and it is common for the billed time to exceed actual time by 30-60 minutes. Similarly, recovery room charges may not accurately reflect the time you spent there. Request the OR log and nursing notes to verify these charges.

How to Dispute Billing Errors

When you find an error, document it thoroughly. Write down the specific line item, the CPT code, the amount charged, and why you believe it is incorrect. Contact the billing department in writing, referencing your account number and the specific charges in question. Request a formal review and correction. If the provider does not respond, file a complaint with your state insurance commissioner or attorney general.

Let BillDelete Help You Find Errors

Reviewing a complex medical bill takes expertise and persistence. BillDelete helps you take the first step by generating a professional itemized bill request that ensures you receive the detailed information you need to identify errors. Armed with a proper itemized statement, you can compare each charge against fair prices and spot the discrepancies.