Medical_Insurance

Upselling, incorrectly listed operating room times, and upcoding are three common errors that are found on medical bills. Upselling is where a doctor may give you a generic drug during a hospital stay then bill you for the more expensive name brand of that drug. Many people do not know the difference in appearance between generic brand drugs and name brand drugs so they will never think to look at the bill. Upcoding is when a diagnosis code is upgraded to a more serious procedure that is more costly. In some cases, operating room times may be recorded incorrectly on the claim. Each time a surgery takes place, the anesthesia record will show the time a surgery started and the time the surgery ended. Since operating room usage is billed per minute, if the times are incorrect, the charges can become higher than necessary. An incorrect operating room time can cost thousands of unnecessary dollars (Consumer Reports Money Advisor, 2009). The general appeals process is for any patient or provider that does not agree with the payer’s decision to deny, downcode, or reduce a medical claim. An appeal can be filed if there are any errors found on a claim. There are usually three steps that must occur during the appeals process. The first step is filing the complaint, the second step is the appeal, and the third step is a grievance. Sometimes the payer may require the claim have errors that equal a specific amount of money before they will begin the appeals process.