Understanding Your Medical Bills – Medical Billing and Coding

It is not easy to understand the numerical codes, acronyms, and terminologies on a medical bill report. But it is logical to understand the medical bills to take control of the health costs. To fully understand the physical therapy billing services or any other medical bills, it is good to know how the insurance company or your medical care provider estimates the cost.

Medical billing and coding

Medical billing professionals are negotiating on the medical bill between the insurance and the healthcare providers. The medical bill they come up with has descriptions, codes, and prices that can be confusing at first. The first step towards understanding medical bills is to understand the terminologies first.

Medical bill terminologies

The following is a list of elements in a medical bill. Unlike the Explanation of Benefits from the insurance company that shows what they cover or not, a medical bill charge shows all costs and breakdown of payments. A comprehensive medical bill has the following elements.

• Statement date
• Account number, which is the unique number given to you when you seek healthcare service.
• Service date 
• Description of the service one receives 
• Charges, billed charges, and adjustment
• Insurance and patient payments
• Amount due column
• Payable to financial details
• Current procedural terminology /service code helps identify the exact supplies and services that one receives at the medical care facility.

Steps to understanding medical bills

1. Request for an itemized statement

That will show the breakdown of charges such as bills from specialists. Getting additional statements from the surgeon, pathologist, or any other specialist can help you understand the medical bill.

2. Check the basic information 

One should verify the personal information on the bill and also health insurance information to avoid claim denial. Ensure that the plan or insurance payment reflects on the medical bill before settling the bill.

3. Review the codes

All medical procedures have a code that determines how much one should pay. There could be a mistake in typing the codes, billing offices misinterpreting the doctor’s prescription or even mistakes in the discharge summary. By going through the medical statement, one may identify unclear descriptions or excessive charges, and through online tools, one can get estimates for such services in their local area. 

4. Check for errors

Medical bill errors are common, and they increase the medical bill. An inflated medical bill charges, duplicate charges, and incorrect insurance information can lead to higher medical bill charges. Reviewing the medical bill to ensure that the medication, treatment, or surgical procedure on the medical bill statement is correct is crucial. Room fees are also another area a mistake may happen. One should ensure that the room fee charges are correct by checking the type of room on the statement and the number of days. Some hospitals may charge room fees for the day of discharge, but most insurance companies do not allow that.

It is advisable to check the medical statement, and if you still feel it is excessive, get a review of the charges using a lookup tool and the codes to find out what a reasonable cost would be. You may then negotiate the medical bill with the service provider.