Heath Care Pricing Transparency and Consumer Rights: Checking bill accuracy
Checking bill accuracy
WHEN THE FIRST BILL ARRIVES (called a "summary bill") ...
- Contact the provider's billing office and request an itemized bill that includes the billing codes (called CPT codes and HCPCS codes). Below is an example of an itemized bill showing the codes boxed in red. Also watch for modifiers. This example shows a modifier "25" on the code for G0383.
- Get the "Explanation of Benefits" (EOB) from your insurance company and make sure they've received the claim and processed it correctly. This guide from the New Hampshire state government tells what a patient should do if an EOB does not match a medical bill.
- Obtain a copy of the medical records. All charges on your bill should be traceable back to the medical record. You should not have to pay for any services which are not noted in the record.
WHEN THE ITEMIZED BILL ARRIVES...
- Google the codes to determine their meaning. Try sites such as Find-a-Code.com or CMS.gov. Check your itemized bill for:
- Inaccurate quantities billed
- Services that didn’t actually happen
- Charging for a more complex or involved service than what was actually provided (upcoding)
- Charging separately for each component of a procedure that should be billed all-in-one (unbundling)
- Inappropriate use of code modifiers to increase charges, such as 25 and 59
- Check your bill for common types of fraud identified in Medicare/Medicaid claims
- More info on billing errors from Experian
Library resources
- How to check your bill for errorsSource: U.S. Center for Medicare and Medicaid Services (CMS)
CPT Professional 2023The library has a copy of American Medical Association (AMA)-authored resources used by health care professionals to report and bill medical services. You may use it to check the codes on your own itemized bills.
Never pay the first bill by How-to guide explains how to check medical bills for accuracy and avoid overpayment.
