Create the Perfect Medical Bill Book Format for Teams with Ease

Medical bill book format for teams

we are gonna talk about medical billing because here's the deal if you have a medical bill in your possession right now the chances are like statistically speaking it's wrong some estimates like this one from Becker's Hospital review from 2016 claim that up to 80 percent of medical bills contain errors funny the errors always seem to benefit the hospital and not the patient but I don't know and these mistakes cost the American people an average of 46 billion dollars per year that's like one-third of Jeff Bezos and it's not just straight up errors because there are basically three ways that you are going to end up overpaying for medical services the first is these billionaires the second is incorrect denials and the third is just straight up price gouging sounds really fun because on average hospitals charge four times their costs to provide a service and then the insurance come company negotiates the discount off of that rate on average providers charge consumers roughly three and a half times what the insurance companies pay now it's no secret that the Health Care system in the United States is very complicated and honestly I think a lot of these issues stem from the fact that the prices are like mostly just made up so with that in mind I want to share a few of the options that you have available to you the little tricks you can put up your sleeve so that you can face off confidently with a billing department and save thousands of dollars so first we need to start with the basics how do you read your medical bill and your explanation of benefits sometimes abbreviated EOB so you can identify which if any of these three issues is happening to you so the first thing to know is the charge Master rate now this is like the MSRP for a medical service and as we stated before it is kinda this is why you'll see a bill for something like an MRI clocking in at five thousand dollars they're literally just pulling stuff out of thin air here then you've got the insurance negotiated rate which is what the hospital and the insurance company agree on and the difference between the charge Master rate and the insurance negotiated rate is the discount discount this is also sometimes called the allowed amount because it's the amount that the insurance company is agreeing to pay for a given service so to extend an earlier example you might find that your insurance company gets you a discount of two thousand dollars on your five thousand dollar MRI but but now you're on the hook for the other three thousand dollars and if the charge exceeds that amount and you saw an out of network provider that's on you fun that process is called balance billing an in-network provider is not allowed to balance bill you anymore for covered services and if you went to an out of network provider but for Emergency Medical Services after January 1st 2022 the no surprises act says you also cannot be balanced build for the difference between the insurance negotiated rate and your charge Master rate so that's like two rare wins for patients we love it here basically the best way to go through this process is as though you've just been handed a scavenger hunt treasure map where the buried treasure at the end is not going bankrupt this process is designed to overwhelm and confuse you so you probably want to just treat it like a challenge because that's what it is everyone say thank you for profit privatized Healthcare says system all right so let's break down how our three most common issues occur on the bill and how you can address them now if you're starting with a particularly large bill I would recommend starting with the largest charges first and then kind of working your way down sometimes things are just plain wrong this is where the billing errors come in now there are two major ways this happens you've got unbundling and up coding unbundling is what happens when something that should have been added to your bill as just one single procedure is basically broken apart and added as a bunch of different things for example in 2014 Duke University had to pay a million dollars after it was accused of unbundling cardiac and anesthesia Services basically the doj said that the hospital at Duke was applying a modifier to the codes so that they could unbundle services that typically were billed together because it helped them get higher reimbursement rates to understand if this is happening to you your bill there's a tool that you can use called the ncci edits validator it's found in the tools menu of find a code under the scrubbing and validation menu it does cost money but you can do a free trial of it if you need to basically allows you to enter all of the codes on your bill and it's designed to run those against a database and flag anything that should not go together now if anything gets flagged you can call your Hospital's billing department and be like hey this is not supposed to be here these two codes should not be together and so we'll link that in the description for you up coding on the other hand that one's a little bit trickier but it's basically where you end up getting billed for something that is effectively more expensive and more complex than what you actually received so what can you do about it this is why getting an itemized bill is so important now the chances that they're just going to send this to you slim you're going to have to call you're going to have to be a pain in the ass but you want to get the itemized bill because then you can look at each individual item that you're being charged for and see if anything looks out of place or like you don't recognize it you're also probably going to see things that you don't know what they mean medically it's like a whole other language so you may need to call your provider and ask for your electronic medical record you want to use that term specifically they are required by law to provide that to you and this electronic medical record has your treatment history so you're going to have another source of reference to see what was actually done to me what did I receive and what am I being built for next up the services that are listed on your build may be accurate but the insurance company might incorrectly deny them so there are a few reasons why this might happen you want to start with the basics name date of birth insurance number and information make sure everything matches because if anything is off off that could lead to a denial the second thing is to check that accounting section you're going to want to look at all the services that it's saying you received you'll see the charge Master rate you'll see the insurance negotiated rate you'll see what the provider is charging the insurance company and you'll see your responsibility now all of that needs to match the bill that you receive and then finally you want to understand if the insurance company denied covered services on your bill and why because that's where you can start an appeals process now like we said it's rare they're going to send this to you just out of the goodness of their heart you're probably going to have to ask and maybe more than once for the itemized bill but once you have it you'll want to cross-reference that bill with your policy documents it's possible that something that you received was incorrectly coded and just needs to be corrected with the billing department in order to be covered it's also possible that it was denied because it wasn't a medical emergency which you can address address by contacting your health care provider aka the doctor of the hospital that you went to and saying hey I think this was a medical emergency if you agree can you include a note and resubmit this to insurance and behind door number three the most fun option everything is correct you are just being charged erroneously high prices that's right the fun just keeps on coming so this is basically what happens when those exorbitantly High rates the made up prices that we talked about earlier somehow end up hitting your bottom line we've all read the horror stories right of somebody who maybe they don't have insurance or their insurance is rejecting something and they're not going to cover it and then they get hit with a fifty thousand dollar bill and then they notice after tracking down the itemized version that they were charged among other things 250 dollars for aspirin now the best way to push for a lower price is to submit something called a settlement offer and you're going to want to send that to the billing department now the backbone of your case is probably going to be built in finder code that resource we mentioned earlier this is going to allow you to enter the hick picks code the hcpcs or CPT codes for these procedures to see what the Medicare reimbursable rate is that's going to give you a more reasonable range on which to base your offer to them this part of the exercise is really just to bolster your argument that the the price that you are being charged is unreasonable and far out of the ordinary and finally you want to argue that this bill is going to create a substantial financial hardship for you now there's a great way to follow up the very next day after you submit this you're going to call confirm that they received it and then ask them how long is it going to take you to respond to the settlement offer you may have to call multiple times but the vibe that we are trying to convey is I am watching this like a hawk I am not going to go down easy and it is of your best interest to work with me here maybe they're charging you five grand for something but you you know that the Medicare reimbursable rate is three grand you might say hey I can pay this for twenty eight hundred dollars today the dirty little secret is that these bills are very often negotiable and hospitals for obvious reasons struggle to collect payment in full so they'd rather get something from you than risk getting nothing that said if you get a no you want to be the world's squeakiest wheel Braden the CEO and founder of resolve medical bills came onto the money with Katie's show this week and he told me the way that they tracked down supervisors and just basically go up the chain in Billing departments by using LinkedIn to fight hospital bills for their customers so if you want to listen to the full interview and go even deeper into this topic you can check out that episode it'll be linked in the description of this video and finally what about the advice to just lose the bill well that can actually work but there are some risks the hospital might send you to collections and if the bill is more than five hundred dollars it will impact your credit report they can also put liens on your property they can issue Court judgments get wage garnishment instruments and while that's not necessarily likely it's an option on the table it could happen and hey if you haven't gotten a bill for something you haven't gotten the medical procedure yet but you know at some point in the future you will and you want to circumvent this entire process you might consider shopping around for medical care yes even if you have insurance you can do this by calling different providers when you know there's a particular service that you need and saying I am a cash Pay customer they're probably going to say oh you're uninsured to which you repeat I am a cash Pay customer and I am wondering how much XYZ costs so in order to figure out whether it's actually cheaper to pay cash you're gonna have to go online and do this sleuthing before you go in for the service but you're gonna need the actual hick picks or CPT code for the service that you're receiving then you should be able to go online and download the charge Master rate for that procedure and the insurance negotiated rates now hospitals are not always super forthcoming with this information they're supposed to post it publicly but very few of them do which makes this very challenging and if you can get them to tell you the cash pay rate you can then cross reference if it's cheaper to go cash pay or to go through your insurance this will also probably depend on where you are in the year how much of your deductible you've already paid and the type of insurance that you have like I said hospitals are required by law to provide this information online but the fine for non-compliance is so low that they just don't I love it here but there are other resources available to you so we also interviewed Jeannie Pinder this week on the show she runs a database called clear Health costs and she's a journalist who's trying to crowd Source this information for different regions so that you can look up a particular procedure and zip code to see what is this going for in this area what are the cash pay rates that other people have been given at places near you this can sometimes help you get a sense for what a good price is because there will be instances where going cash pay actually is cheaper than going through Insurance of course maybe the best advice for dealing with egregious medical bills is only ever having medical emergencies in countries that have Universal Health Care that's all for this week but as I said if you want to hear the full Deep dive on medical billing errors you can check out this week's episode of the money with Katie show in the description of this video and if you like these videos you found this helpful please give it a thumbs up bye