Medical Billing Problems
Essay by nikky • September 13, 2012 • Research Paper • 812 Words (4 Pages) • 1,393 Views
There are times when a person files a claim for a medical procedure or service and they run into
a problem with the billing. There are times when a medical professional or facility does not
receive payment for a procedure or service rendered, because of a problem with billing. There
are billing problems on both sides of the transactions. These problems are not limited to the
consumer, health care professional, or the insurance companies. Each group or person may
have a problem only on their part of the billing. Problems that involve medical billing are not
just financial. The range of problems is diverse and far-reaching. There are problems that
include medical claims denials due to some type of error. Blue Cross Blue Shield deals with
medical errors, which are referred to as "never events". (Health Management Technology,
2008). There is always the ever present problem of incomplete and/or incorrect claims that are
filed. There are several things that can be done to decrease the number of medical billing errors
that occur here in the United States and abroad. Chart auditing is just one of the ways to help
keep track of medical billing. Checking that the right documentation is submitted is another
way of preventing billing problems. As the old saying goes where there is a will there is a way,
and we will cover not only the problems, but the solutions as well.
Up to 30% of medical claims filed have some error that causes it to be denied. Some of these
errors are never re-billed or re-filed, so health care providers lose millions of dollars. The
problem with re-billing may be because it is very time consuming to review each denial. Many
times there are hundreds sometimes thousands of claims that are denied because of varies
reasons and at varies stages of the filed claim. When medical personnel has to be taken away
from other assigned task to review the denials it becomes very costly and a waste of valuable
manpower. There is also the problem of the documentation not being filed within certain
timeframes. (Health Care Collector, 2009).
"Never events" are medical errors that should have never occurred, such as wrong procedures
being preformed, or a patient being given the wrong blood type. When there are medical errors
such as serious infection occur at a medical facility, certain medical insurance providers will not
pay the claims. When these type of errors occur it is known as a "never event". These kind of
errors are rarely ever billed to the consumer, but because of the intricacies involved in billing
some
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