Published by admin September 30th, 2008 in News.Closed
You don’t expect to pay for something that was done wrong. Starting October 1, 2008 the Centers for Medicare and Medicaid Services (CMS) have said they won’t either. The CMS will use its financial clout to improve patient safety and control costs by no longer paying for what are known as “Never Events”.Defined by several national quality measurement organizations, “never events” include surgical errors such as procedures performed on the wrong body part or on the wrong patient. In addition to wrong-site surgery and serious medication errors, “never events” also include a variety of other complications. Initially they started with 8 events but now have expanded the list to 11. Continue reading ‘Never Events and You’
Medical debt is the second most common reason why American’s file bankruptcy even those with insurance. A frightening statistic from the Federal General Accounting Office study reported that as many as 95 percent of all hospital bills include overcharges This could make for an interesting conversation during the cocktail hour at the American Hospital Association convention.
Hospitals will use the excuse that it is nearly impossible to keep up with the various billing programs of 40 to 50 different insurance companies and Medicare and Medicaid. All of these organizations have their own forms and codes for “who’s covered for what, under what circumstances” rules, and own billing and payment systems. “The medical billing system is complicated and confusing,” admits Rick H. Wade, senior vice president of the American Hospital Association, which represents most of the hospitals in the United States. On Dec. 27, 2002, he told a “Dateline NBC” investigative team, “Trying to understand all the code words and jargon can turn your brain into oatmeal.”
Many hospitals overprice procedures and supplies egregiously. “It’s not unusual to see supply items marked up sometimes as much as 1000 percent,” says Randall Marrs, owner of Medical Audit Recovery Services in Tulsa, Okla. “I’ve seen an oral swab billed for $55, when a package would cost you $2 at the drug store.” Saline solution, which is often billed as much as $75 per 1000 ml, costs the hospital no more than 35 to 40 cents, he adds. Those are details you may not notice if your hospital co-pay is a fixed amount. But if you have to pay a portion of the bill say 10% or 20% you’re paying part of those inflated costs.Continue reading ‘Medical debt is the second most common reason why Americans file bankruptcy’
Here are the most common areas of overcharges and errors, with tips on what to do if you find irregularities:
Charging for the day of discharge. Most insurance plans do not allow hospitals to charge for the day you leave the hospital.
Number of days in hospital: Check the dates of your admission and discharge. Were you charged for the discharge day? Most hospitals will charge for admission day, but not for day of discharge.
Charging for a private room when you had a semiprivate room, or charging for a private room when a semiprivate room was unavailable.
Charging for medications you didn’t receive or refused, or for high-priced brands when your doctor prescribed a generic.
Charging for the same procedure or service twice, aka “double billing.”
Charging for tests that are grouped under a broad category like “blood work” or “miscellaneous.” Always ask for tests to be itemized.
Charging for services that your doctor did not order or that may have been scheduled but later cancelled.
Charging for a test twice because it was administered incorrectly the first time or the first test results were misplaced.
Charging for personal items that are usually included in the room charge like slipper socks, toothbrushes, lotions and combs.
Charging for physician services when the doctor sends you a separate bill for the same service.
Charging excessive amounts due to a clerical mistake which results in the wrong code for a service or procedure.
Charging for more operating room time than was necessary for your surgery. Check your anesthesia record. It will show when your surgery began and ended.
Up coding: This common billing mistake occurs when a doctor switches a high cost medication or expensive service for a cheaper alternative then charging for the more expensive item or, in some cases, charging for both!. An example of this would be the doctor replaces a top dollar brand name medication for a generic alternative.
Keystroke error: An everyday mistake in which someone just happens to hit the wrong keyboard key. An innocent enough mistake but one that can cost you a significant amount of money.
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