So, continuing along with my last post - why are there so many errors on hospital bills?
This is a good question. Hospital bills are all billed on a claim form called a UB04. This is the industry standard for any facility fees. On this form, it is required to use something called a Revenue Code. In simple English, what this means is that all of any one type of code will be grouped together and billed as one line item. For example, all of the medications that are given will be lumped together under one charge. So instead of seeing something like this:
05/16/14 1 aspirin $2.00
05/17/14 2 Motrin $3.00
05/18/14 IV fluids $5.00
You will see on the billing
Rev Code 250 misc drugs $10.00 quantity 4 (with no date, since they are all grouped together)
If the insurance company comes back and requests an itemization of the charges, it is then provided to them.
So, without every single line on every single claim being examined, it is easy to let things slide through sometimes. Hospitals are diligent in trying to keep these at a minimum. But as you can see, without a full and detailed audit, errors cannot be easily visible.
So why don't they all get audited?
Time. Or lack of it.
If an insurance company sees a trend, they will investigate. If a patient has a question, an audit will be done. But in the absence of a reason to do one, generally speaking they will not be performed. And (the next blog post) with most reimbursement schedules small errors won't really matter anyway. More about that to come.
So, the lesson here is, keep an eye on your bill. Question what you do not understand, and seek help when you need to.
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Reach me on Twitter @LorettaLea
Author, Medical Billing, Coding, and Reimbursement
A medical billing professional for over 30 years now, I have seen a lot of changes in this field, and there are a lot more on the horizon. Follow me as we see what they mean and for who.