Over the past year, at Merem Healthcare Solutions, we have had coworkers, family members, friends, and even doctors ask us to look at their personal medical bills to see if they were accurate. To our surprise, only around 60% we have reviewed recently were accurate.

A friend of mine had a bill from a lab for $1,200. As a nurse practitioner herself, she knew there was no way a routine lab could cost $1,200 (that’s crazy!).

She emailed us with this, “Hope everything has been going well for you. I had a quick question and thought you may be able to help me. So, I went to my MD for some routine blood work because I had been having some weird headaches and I get this bill in the mail for $1200 for the blood work because my insurance straight denied the claim. They said the diagnostic codes were coded incorrectly but wouldn’t give me any more information? When I talked to the doctor’s office, they didn’t have any clue on how to fix it. I know you all have experience with this. I was curious if you may have any ideas on what went wrong? I can send you a copy of my bill if you need to see it. I’m at my wits end here!”

This is what feels like the thousandth message like this I have received this year. “Yes, I can definitely help! This happens often when visits are inaccurately coded. What type of insurance do you have?”, I replied.

She replied with, ” Here is the bill I got…” I am not disclosing her personal information for obvious reasons, though I have her consent to share this story.

As a Certified Coder, I knew this was incorrect. Most doctors do not perform procedures, diagnostic tests, etc. unless there is an indication for it (medical necessity).

Together, we called the billing office that had sent this outrageous bill. With her consent, I was able to talk to the billing office. I said, to the nice billing representative, “ma’am, she is being billed because the insurance is not covering these charges stating they are non-covered. What diagnosis was billed for this blood test?”. I asked this question because, being in the billing industry for some time, I knew medical necessity (non-covered) denials come from inaccurate diagnosis coding.

She responded, ” The diagnosis billed was for hair loss”. My friend immediately chimed in, “but I never said I had hair loss nor have I ever had hair loss.” I knew right then, we had found the issue…. Inaccurate coding.

So often, billing offices and practices put more attention to procedure coding because it drives revenue, but they still must be accurate in diagnosis coding. My friend, referenced in this article, will likely never go back to this lab. It’s not because of bad customer service, and not because the facility could have been nicer. It’s not because of anything other than they didn’t look competent due to inaccurate billing. Your billing office reflects on your practice, whether you like it or not.

About 30 days after I helped this friend resolve her bill, she called me to share the outcome. Apparently, instead of owing $1,200, she owed part of her yearly deductible ($115.87). We essentially saved her over $1,000! I can only imagine what would have happened had she not asked MEREM Health for some friendly assistance.

Make sure you have the right billing staff in place! Call us today to see how MEREM Health can help your practice.