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Basic steps you can take to determine if your medical bills contain over-charges; how to detect errors and what to do about them.
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How To Be Your Own Healthcare Consumer Advocate
Courtesy of: Montana Medical Bill Review
Overview: Medical Billing ProcessConsumer (patient) goes to doctor,
hospital, or other provider for prevention or treatment
Data collectionServices rendered and documented Billing document generated using
collected data and codes from patient’s medical record
Electronic claim form submitted by provider to insurance company (If no insurance, payment collected from patient.)
Provider receives payment from insurer in 30 days
Anatomy of a Medical Bill
Doctor’s Office Visit
Hospital
Physician Service – Inpatient
HCPCS CPT DRG
RBRVS CMS R&C
ICD-9CM ICD-10CM
Top 10 Things You Can Do to Help Find Billing Errors
Check Name Check DOB Check Account Number Check SSN Check New Patient vs. Established Patient Request a detail bill Check type and number of procedures (X-rays, lab
tests, EKG,etc.) Hospital bill – check inpatient vs. outpatient
status/number of days Check room rate – Private vs. SemiPrivate/ICU, etc. Check type and amount of medications
Working with Provider or Insurance Company to Correct Errors
Collect all your information (bills, account statements, EOB, cancelled checks, credit card statement, insurance policy number,etc.) and have it available to refer to, before you contact provider or insurance company customer service
Remain calm Smile when you talk on the phone Provide necessary information to verify your identity and account
number Briefly state your issue/concern/questions Ask for clarification of any charges or insurance payment denials Specifically identify billing errors Request a corrected bill If necessary, use the appeals process outlined in your insurance policy to
appeal a claim denial you believe is in error Follow up: review account statement from provider to confirm
corrections; review subsequent EOB from insurance company to confirm claim status/payment
Thank You !