COMMON HOSPITAL BILLING ERRORS


Dates of service. Pamela Wilson, a nurse for American Medical Bill Review, a Redding, Calif., firm that works for insurers, says that most plans do not allow hospitals to charge for your discharge day, although hospitals frequently do so anyway. The day you entered the hospital can generally be billed as a full day, however, even if you were admitted late at night.

Duplicate or incorrect orders for medication, lab work, tests, or room fees. Compare the charges on your bill with the doctor's orders. Hospitals may bill a patient for a procedure even though the doctor cancelled it. Also, if you were charged several lab fees on one day, call your insurer to check whether the charges should be bundled. For example, you might be charged for a number of blood tests in one day that should be combined as one charge. Room fees may come with à la carte extras. "I often see charges for supplies like sheets, towels, and gloves that should be included in the room charge," says Pat Palmer, president of Medical Billing Advocates of America (MBAA), a Salem, Va., group that checks bills for consumers. Palmer is also coauthor of "The Medical Bill Survival Guide" (Warner Books).

Operating-room time. Your anesthesia record will state the times when your surgery began and ended. Operating-room use is billed either hourly or by the half- or quarter-hour. Rates vary from $500 to more than $2,000 per half-hour. You may find, for example, that you were billed for four hours for a procedure that actually took only three.

Fraudulent charges. By carefully reviewing basics such as your dates of service, you may be able to spot more-unscrupulous practices. Brennan, the fraud investigator, says he found one ophthalmologist's office manager who billed patients legitimately for surgery on one eye, and then routinely billed for surgery on the other eye two weeks later--even though no second surgery occurred. "Over six months, she stole over $45,000," Brennan says.

You may also spot charges for more expensive services or procedures than were performed. Commonly known as upcoding, the practice inflates the patient's diagnostic code to a more serious condition requiring more costly procedures. Although it will take some time and effort, you can double-check the doctor's orders against the diagnosis to make sure it is consistent with the procedures listed on your bill. You can check codes on the web at www.cdc.gov/nchs/icd9.htm.