Hospital Codes to Check Charges on Your Bill

I heard about this site on the radio tonight. It's a site that tells what all the codes are on hospital bills. The person giving the information said to check for particular items on the bills, such as procedures that weren't done, meds that weren't given, etc. He said to look for typos, like an extra zero (i.e., $80 medication that they are charging $800 for), or multiple entries for the same thing. This guy said if the wrong thing has been typed in, or the wrong code used, your insurance company will AUTOMATICALLY not pay it, and that part of the bill is passed on to you.

The site is http://icd9cm.chrisendres.com/, or you can just google ICD9 to find it. It takes time to check everything, but could be worth it.

Sue

Thank you.

This is very timely for me Sue.

Wife is getting major surgery in 2 weeks and we haven't been thru anything like it before.

I loved the $4 per pill ibuprofin they charged us for 6 times a day when we had a $4 bottle of 200 in her suitcase that we brought with us for the birth of both of our children.

Glad this is coming up again. My family has had a lot of medical bills the last six years, hundreds of thousands of dollars going to insurance, (and quite a few tens of thousands going to me). I can comfortably state close to 10% of those bills are bogus. Whatever the reason, fraud, typo, honest mistake.

The first way to be proactive is to insist that the first time every nurse, doctor or specialist visits you they leave a biz card or signs a sheet on a clipboard you provide. This sheet has date/time, their name, position/department and how you will be billed, (i.e. a private practice or group medical organization like 'team physician').

The second way is when you get your bills you scour them for names you do not recognize or organizations that are not on your clipboard or business cards. Then fight it.

Paying $6 per OTC pill is annoying, getting a bill for $400 from a doctor who looked at your chart at the nurses station while you were asleep and billed you a full consult after scanning the pages, is criminal. Its happen to me once and my son a few times.

"I don't have your card (or your name is not on my sign in list), you prove to me you did what you said you did." Stops a lot of issues cold.

I had a roommate whose mother died in the hospital after two weeks in intensive care. Her own doctor sent a bill to the estate for a hospital visit and exam... for the day AFTER she died.

Sue

WARNING: Long post. Self-serving and defensive. Please have mercy!!

I share with many a sense of anger and frustration with healthcare costs. I also know and deal with many healthcare providers, insurance companies, and facilities on a daily basis. I've unfortunately had significant recent healthcare costs myself, with billing and insurance errors I had to dissect to correct. Perhaps I'm overly defensive here, and I expect I'll be bashed soundly, but here goes: I have very very rarely encountered anything but a well-mannered response and good efforts on the part of those players to correct errors (as long as I tried to keep my own cool). I have seen errors (some human, some a function of "systems"). I have never encountered intentional fraud. I have made such errors myself: I don't steal from people, or "systems", and I truly appreciate it when any billing error I have made is brought to my attention to correct. This has been my experience with every healthcare provider I have worked with, also. So we're not all crooked or unconcerned about these issues. We're people just like everyone who reads this forum. There are many of us ON this forum.

An example: Twice in the last three weeks I was angrily contacted by a patient of mine (two different patients) who were venomously enraged at what they felt were excessive and unfair charges from a doctor to whom I had referred them (two different doctors). Yet, the patients were wrong in both cases. In one case the doctor's office had noticed the error, corrected and credited the patient's credit card charge, and sent a letter of appology to the patient. In the second case the office did the same, but the doctor personally called the patient to appologize and offered to see them at NO CHARGE for the office visit the patient didn't get. They did this unprompted by me, before I even contacted them, and (more important) before either patient had even mentioned to them the error. .

[O.K. Naro....stop being so defensive!]

I've cut and pasted some of the comments and suggestions, and added my thoughts FWIW:

"to check for particular items on the bills, such as procedures that weren't done, meds that weren't given, etc. He said to look for typos, like an extra zero (i.e., $80 medication that they are charging $800 for), or multiple entries for the same thing.....just google ICD9 .....I can comfortably state close to 10% of those bills are bogus. Whatever the reason, fraud, typo, honest mistake."

I've been happier with the outcome when I start with the assumption of a "typo..or honest mistake".When I didn't understand the code or terminology, the insurance company or facility billing office politely explained it to me. I have never had a problem getting such errors corrected. Perhaps I've been truly lucky.

"if the wrong thing has been typed in, or the wrong code used, your insurance company will AUTOMATICALLY not pay it, and that part of the bill is passed on to you"
Not in my experience. Particularly if you are on a PPO or other "panel". If the wrong thing has been typed in and the insurance company disallows the charge, they are just as apt to deny the facility/doctor the ability to "balance bill" and typically that means that the charge CAN NOT be passed on to the patient. I also see insurance companies paying for these errors when they should NOT have. When I've been civil (sadly, not always my first manner) the error was corrected: but it can take a few "billing cycles" to do this and meanwhile each bill I got ticked me off anew.

"we had a $4 bottle of 200 in her suitcase that we brought with us.... bring your own meds with you"

Can you imagine a patient bringing their own pills... but being mistaken about what the medication was or how it was to be taken? It absolutely happens, even with simple drugs like Motrin. The way to handle this is to have the physician write an order permitting the patient to take his/her own meds., which most physicians will do (after hopefully looking at the meds. to confirm). But the nurses or the hospital shouldn't take the authority to do this. Your doctor should.

"getting a bill for $400 from a doctor who looked at your chart at the nurses station while you were asleep and billed you a full consult after scanning the pages, is criminal"

Is it criminal? What are the specifics? Believe it or not there are many circumstances and medical specialists in which the "consult" does not require examining the patient. Perhaps it would be courteous to do so even if not medically necessary. I have had circumstances myself in which everything I needed to render a competent consultation was in the chart, and to even talk with the patient was inappropriate. So I can't go along with the blanket assumptions in the post without some details.

"Her own doctor sent a bill to the estate for a hospital visit and exam... for the day AFTER she died."
I once billed a deceased patient for a visit which on the bill was dated after she died. I was mortified! I posted the wrong date. I saw her before she died. In fact, had I known she died, I wouldn't have sent the bill in the aftermath anyway. But my error was in a digit on a billing slip. Might we start by assuming the same about the doctor referenced above...give him/her the opportunity to correct a possible error... before reaching any conclusions?

O.K....I'm braced. Beat me up.

NAro,

A well reasoned response. I appreciate the insider view. Ihave not had the problems some others have. In the last year we did have to deal with a spontaneous pneumothorax, and subsequent operation, with my son. I went to all the billing agencies and asked for any clarifications on the bill. Everything was in order. The errors that were made were the $%&%@ complex coding required by the whole system. I was never required to pay for anything that was miscoded. Everyone was very understanding during all of this. TriCare (retired military medical) was very helpful also.

Add-on: I downloaded the codes and authorized costs for my area. I was able to confirm all charges and procedures to the penny and letter.

The error doesn't have to be a deliberate act to cost you money.

Do you look at your car repair bill? Your grocery receipt? Of course, if you have so much money that it tires you to carry it around, just look at the bottom number and pay it.

Personally, I think all those codes are confusing to the patient AND the billing people.

The doctor in the incident I mentioned showed a list of charges that he was there every day. When called, he insisted that he DID see her on that day, and threatened to take her daughter to court to collect. And the daughter was ALSO his patient.

Some people and some businesses are too stupid to trust. Check them out.

Susan,
I hope I didn't sound like I thought any of us should pay or be charged in error. Of course, check it out. I agree with you.

I agree with you about the ICD-9 codes being confusing. Unfortunately they are international, not just U.S. codes. They are also mandated by the federal government, so we have little power and little choice. I don't like it either: if I could recover some of the time and effort it costs me to unravel this &+*!T I could spend more on my survival toys.

The issue you relate about the doctor and the deceased patient is despicable, and I'm not implying that you're incorrect in what you reported. But I appreciated your words "some people".....In my experience this is so rare that perhaps THAT is what disgusts me so much about the doctor you report about.

+1 on scouring both what you are billed for and what your insurance is being billed for.

After being told by: 1) the doctor, 2) the lab tech, AND 3) the office manager of the doctor's office that we would NOT have to pay a co-pay ("not ever charged") for coumadin blood tests done at the doctor's office which were done when we were not seen by the doctor, we were later billed for the co-pay. The "billing office" decided that it was allowable under our insurance since it was an "office visit" (as we physically went into the office, were seen by the lab tech), that we had to pay a co-pay. They were paid for the lab test also, by the insurance. Now, if we had gone to the local office of one of the big labs, insurance would have paid the same lab fee, but we would not have incurred any doctor office co-pay.

When we were questioning the Doctor's billing office about this issue, we were told that "medical billing is complex and you don't understand it.

We are fighting these co-pay charges. Currently, we have a consumer complaint in mediation at the State of Maryland Attorney General's office over these, what I think, are bogus charges. I also think that because we asked, and were told that there were no co-pays for these visits, they waived any right to charge us for them later.

Yes, mistakes are made, and medical billing is complex. But at some point, you have to recognize that some people and organizations are not to be trusted.

okay so saying 'criminal' was not meant as such in the legal sense, more of the act of trying to take money for doing nothing.

Much like if a plumber came to my house, looked in my window, saw my sinks were not flooding and sent me a bill.

A doctor, who is not involved in my care -in any way- doing a drive by the nurses station, and billing me to pad their account is flat our wrong and dishonest. Since that is too many words, I insert 'criminal". Maybe I should insert morally first.

Actually, I don't mind the use of the word "criminal."

Taking money for something a) you did not do and/or b) said you would not charge for is fraud, which, I think, is a criminal act in most places.

They charged me $18 for 1 pill I took while at the hospital!! My entire prescription for 3 medicines was like $21, and I don't have insurance for those meds either!! Hospitals are rip-offs.

All this horsing around seems like a genuine waste of time and energy. But "fixing it" would probably make it worse.

Proof that it takes a computer (and coding system) to REALLY foul things up!

This is a very good idea - BUT - remember not to be confrontational. I had a medical plan with a very high deductible - $5,800 per year - and for me, I wanted to make sure all the expenses were being credited toward the deductible. Same basic rules - different purpose.

I found that logging each and every interaction was tedious, ridiculous and complicated, and it was well worth it. Many expenses that "did not apply" for the deductible actually did.

Also, make sure you have a FULL COPY of your health plan - with ALL riders - and be ready to read it all, and be ready to cite from it repeatedly.

It's a battle folks - no doubt about it - and you can win with better information.

If you think there is confusion with ICD-9 (17,000 codes), just wait when ICD-10 (155,000 codes) becomes the rule in the US (2013, national variants already in use in Australia, Canada, Germany, and Sweden)

Not all "office visits" are with the physician. Properly coded it applies in Coumadin Clinic for care by an APN,PA,Pharmacist, RN - varies by state regulation and insurance carrier.

Not to justify, but to add explanation: Specific charges from a hospital do not usually reflect the actual cost of a specific item, but reflect a markup, usually variable (the higher the cost of an item, the lower the percent markup). This allows a hospital to cover costs you're not specifically billed for, ie cost of housekeeping,laundry, electricity, water,food services, etc. Yes it would make more sense to roll these into the daily charge (room rate), but that's not how its done for many reasons(some historic, some due to strange cost accounting rules from outside entities).

Medicine has become a poorly, partially controlled utility with significant legal restrictions on collective bargaining and the ability to share certain non-medical data between groups that could lead to efficiencies and cost savings.

I agree with NAro's comments (#182008).

I brace for the onslaught.

If you can't dazzle them with brilliance, baffle them with bull***t.

Susan

My Grandmother used to say "bull***t baffles brains"

OK, here's the thing I've run into. Inconsistent coding schemas. 155,000 codes - if EVERYONE uses them is better than any number of slightly inconsistent coding schemas used in different places. Anyone who works in data translation knows that errors in field mappings can lead to ever-larger headaches down the line.

Kind of reminds me of the old urban legend that the first World Standards Day was held on three different days worldwide (it wasn't but it did take them from 1946 to 1970 to settle on a date).

http://en.wikipedia.org/wiki/World_Standards_Day

Let's steer this topic a little bit, and let's commiserate on something we all need to think about, which is closely related to the OP.

Electronic Health Records. No matter what you think about health care and who/what should provide it, and no matter what plan or lack thereof you favor (and that's a TABOO topic here, BTW), there's a serious effort at pushing Electronic Health Records on to all of us. As a long-time geek, and a guy who sits in front of a computer 14 hours a day, I can say with a high degree of certainty that EHR's as they are being implemented are an extraordinarily bad thing. Heresy, I know, but that's how I see it. The entire EHR concept is roughly analogous to farm animal management software, in which, with point and click ease, you can record medications, inoculations and so forth for your cows, pigs, sheep, whatever. If you feel like a number now, EHR's literally reduce you to a record in a (proprietary) database.

And EHR's are fertile ground for marketing-based medicine. Using their decision-tree inputs for symptoms, the temptation for the software maker to "sell" a recommended treatment that pops onto the screen is very, very large.

In addition, the EHR systems as they stand completely leave out the patient. I was at a hospital for a broken wrist a couple of years ago, and they used EHR's and digital imaging. When I was looking on the screen at the X-Ray I asked the radiologist for a copy of the file...I handed them a USB key drive. He looked at me like I had handed him a steaming turd. "OK then, please email me the file." - again, stunned disbelief - "Oh, we can't do that..." - OK then, what CAN you give me - "We can print a film for you, but you'll have to pay for it yourself." - ummm....ok, well what's the big problem here, why am I excluded from the medical records? They are about me after all.

Even worse is that the systems I've seen and read about aren't compatible. If I ever move and my new doctors aren't on the same system as my current doctors, well then what? Print everything out? Who pays for that? Who re-keys? Do we really trust a data import scheme? What about data synchronization?

At this point, I generally carry a netbook with me everywhere and when I interact with ANY for-profit entity that could/will bill me, I log all of the communications and actions - and that includes medical professionals. I just have had too many bad experiences with their record-keeping motivations.

Do folks have to pay a discretionary 10% service charge for a Hospital bill i.e. something like a tip in a restaurant for good service?

Sorry for sounding obtuse but I've never seen a hospital bill.

Behave or step off this topic. You know how things are here in the USA on this matter.

I despair when I think of EHR.

It's already nearly impossible to get one's credit records fixed. And there are only 3 agencies involved.

Now expand that to all the healthcare outfits who could put an error into your records wherever they may have propagated to.

I already have one specialist who thought I'd already had that part REMOVED because the referring office coded it so......


Hey! I just thought of the bright side of an EMP attack :-)

Ah...a fellow thinker.

And what about the mistakes they WILL make?

That little snip about being allergic to sulfa or other meds just disappeared?

"Hey, Doc, just how many times can you remove an appendix, anyway?"

Julia A. Smith records transferred to the records of Julia B. Smith, SS and all.

Right now they're advertising prescription drugs on TV, directly to possible consumers... WHY? The consumer shouldn't be making the decision that he/she needs it.

Marty's right, it would be a nightmare.

+1 on the benefits of an EMP!

Sue

In all fairness, a lot of billing errors stem from, I believe, an institutional lack of awareness and a lack of clarity on the part of those that actually bill.

Sure, there are the ICD-9 codes. For example, systolic hypertension, primary hypertension, and essential hypertension are all different diagnostic codes, but can be used fairly interchangably( esp primary and essential).

then there's the CPT codes, which are billing and procedure codes.

Then there are the HCPCS codes.

So, really, in addition to all the medical stuff, you expect doctors to be financial whizzes too? Have you actually tried to sit down and bill a regular office visit? There's all sorts of criteria, some vague, on how to bill even that. Do you add a -25 modifier? No? Was this simple, complex? Both? How much time was spent "counseling" versus "treating?" What counts as either, when so much of therapy is education?

You think it's tough to pay, try billing it. I seriously doubt many folks out there are trying to scam money, ESPECIALLY since so many folks can't pay for it anyway!

All this crap just because people have come to expect medical insurance to work miracles. It's like having car insurance that pays for oil changes and gas.

I could imagine pulling into the gas station...

Let me see you're gas gage. Hmmmmmm... interesting. Looks like you'll need a complete fillup. Don't worry, your insurance covers premium.

Two months later you get a bill from the gas station for $53,235.56 You call your car insurance company and find out that it only covers generic premium gas. Plus there's that oil change that was with regular oil that accidentally got coded for synthetic so it was rejected alltogether and charged to you at the non-group rate. A new oil filter cost $10 over the counter at the auto parts store, but they used your belts, hoses and filters prescription plan which covers it with a mere $20 copay.