Whether you’ve been to the hospital for an emergency, or to your primary care doctor for a routine checkup, trying to decipher the codes and terms on the bill you receive can be confusing and overwhelming. Before paying any medical bill that was sent to you, it is important to review it thoroughly to make sure the information is accurate and correct, including the basics such as your insurance information and dates of service. In addition, in order to ensure that you are being billed appropriately, it is first necessary that you understand what the information contained on your bill means.
Any codes or services listed on your bill must correspond with what is included in your medical record. Unfortunately, it has become all too common for medical bills to contain inaccuracies. In fact, according to statistics provided by the Medical Billing Advocates of America, as many as 80% of medical bills contain errors. Fraudulent practices such as upcoding and unbundling procedures, as well as careless mistakes, are all scenarios which can result in an unwarranted bill.
Understanding the List of Services
One of the first things you will notice on your medical bill is the category called “Service Description.” This is the list of medical services that were rendered during your visit. This list contains many medical terms, most of which may be unfamiliar to you. Nonetheless, you should take the time to make sure that you actually received the services documented on the bill. It may be helpful to do a Google search to clarify any unfamiliar medical terms.
Types of Codes on Medical Bills
Depending on the type of medical services you received, different types of codes will appear on your bill. These codes are used to identify services and procedures documented in your medical record, as well as for billing purposes. Each service provided is billed as a separate code and line item. The following are a list of codes commonly found on medical bills:
Current Procedural Terminology (CPT) Codes
CPT codes are each five characters long, and include a series of numbers and letters. These codes specify the procedure that was performed and serve as communication between the medical provider and the insurance company for billing purposes.
Similar to CPT codes, in that they indicate the types of procedures performed, HCPCS Codes were developed by the Centers for Medicare and Medicaid specifically for Medicare, Medicaid, and private insurer reimbursement. These types of codes typically signify reimbursement for medical supplies, devices, medications, and transportation, among other services.
Not to be confused with CPT codes, these types of codes are used for diagnostic purposes to explain to the insurer the reason for the procedure. They specifically indicate the diagnosis and must be matched with a corresponding CPT code for reimbursement.
Other types of codes that may appear on a medical bill can include ICF codes, which relate to functioning and disability; DRG codes for Medicare reimbursement; NDC codes to identify drug products; and DSM-IV-TR codes for psychiatric diagnoses.
Difference Between the Bill and Explanation of Benefits (EOB)
Although your medical service provider may send you a bill or statement, another document that you may receive is what is called an Explanation of Benefits. This is not a bill. This is a document that is sent by your insurer to explain how the claim was processed.
In addition to reviewing your bill, you should also take the time to look at the EOB to ensure that the dates of service, procedures, and all other information correspond with both documents. If there are any procedures that your insurance company did not cover in whole, or in part, you may want to access your patient portal with both your insurance company and health care provider for clarification.
Contact an Experienced Medical Bill Advocate
If you have received an unwarranted medical bill, it is important to understand your rights and recourse. An experienced medical bill advocate can help fight an erroneous or excessive bill and save you thousands of dollars. Systemedic is a nationally-recognized medical billing advocacy company with decades of experience in helping victims of fraudulent and unethical medical billing practices. If you are experiencing a medical bill dispute, contact Systemedic today at (845) 639-0007.