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Billing Errors: You may not catch them, but we will.

Billing errors: you may not catch them, but we will.

Charging for non-billable services happens on both inpatient and outpatient bills. These charges are the cost of doing business as a hospital and should be included in the room or procedure charge, not billed to the patient. Here are some examples:

  • routine services: IV starts, set-up fees, venipuncture and finger-stick collection fees
  • routine supplies: gowns, drapes, gauze, elastic bandages, adhesive tape
  • routine equipment: charges for equipment commonly available to patients or usually supplied to patients during the course of a procedure, e.g. IV poles, pumps, scissors, clamps, etc.

Routine charges from an actual bill:

Billing Errors Chart 1

Admission Day Room Charge

When a patient occupies another area, such as the ER, prior to occupying an inpatient bed, the ER occupancy should not be recorded as an inpatient day.

Here’s how the overcharge happens:
The patient enters the ER on 2/15 at 1:00 pm, and taken to OR for surgery at 10:30 pm.  The patient leaves recovery and is moved to a hospital room at 1:45 am. The bill contains two room charges for 2/15:

Billing Errors Chart 2

The $790.00 charge is not valid.

Laboratory Panels

Individual tests that make up a lab panel cannot be separately reported. This piecemeal or fragmented billing yields a fat reimbursement for tests or procedures that should be billed together or under one code at a lower cost.

Billing Errors Chart 3

Procedure Codes 82374, 82435, 84132 and 84295 make up the Lab Panel 80051 – Electrolyte Panel. The 2008 national average fee submitted for Lab Panel 80051 is $28.26.

Diagnostic Imaging

There is a multiple procedure payment reduction on the technical component (TC) of certain diagnostic imaging procedures. The reduction applies only to contiguous body areas.

Billing Errors Chart 4

On this bill, both CT scans apply to contiguous body areas. Therefore, the charge for 74150TC should actually be half, $302.50, not $605.00.

Items Never Ordered Or Delivered

Sometimes patients are charged for items that the doctor did not order, or charged for items that the doctor did order but the nurse never delivered.  If the item wasn’t ordered, there should be no charge, and any item ordered but not delivered should not be charged.