How to Audit Your Inpatient Hospital Bill

If you are a cash-pay patient and required a hospital stay, you should audit your bill and check for errors and/or illegitimate hospital charges.   Despite what some may think, you do not need to be familiar with medical coding and billing or medical jargon in order to identify some of the common errors that result in adding hundreds or thousands of dollars to a hospital bill.

Once you receive your bill, notify the hospital that they need to put your account on hold until you receive the information that is necessary for you to review the charges on your bill.  This is not an unreasonable request.  Inform the hospital that you will need your medical records and the charge master.  A charge master, or detailed itemization, is a list of items and services received during a hospital stay broken down by date. 

Room Charges:

Were you billed for a room on the day of discharge? If you were, this is not a legitimate charge, and this charge should be removed easily.

Look at the description of the room. Was it billed as a private room, but you shared a room or did the room have another bed available? Also, review the level of care. Were you billed for an ICU room but were never in ICU? If the answer is yes, these are charges that should be reduced without any trouble.

If you had surgery during your inpatient stay, examine the medical records alongside the charges for the surgery room and recovery room. These charges will be broken down by the hours a patient spent in each room, and, due to data-entry error, these are charges that might add hundreds of dollars onto a hospital bill. If medical records indicate that you spent three hours in surgery and the bill reflects six hours, this is another charge you are able to reduce.

The same is said for recovery room charges. However, there is another item of interest for recovery room charges. Sometimes, a patient will be forced to stay in the recovery room when it is unnecessary, because a room was not available. Recovery room charges are costly because of the constant monitoring involved—ensuring a patient is not having an adverse reaction to anesthesia, monitoring pain, pain management, etc.—and, often, you may be able to determine by reviewing the medical records if there was any wait time due to a room being unavailable or waiting for the completion of room preparation. If you are able to identify this situation, the additional and unnecessary recovery room time should be disputed.

Creative or Unnecessary Charges:

Do you see a charge for “oral administration”? If so, this is the charge for a nurse handing you a pill. This is a ridiculous charge and should be disputed.

Also, look to see if you were charged for Kleenex, toilet paper, soap, etc. You should dispute these types of charges by saying that these are things included in the room charge. This should be done with any item that was available in the room when you entered it. Think of it as a hotel stay, and ask yourself if it is reasonable for a hotel to charge you separately for the items in question.

Duplicate Billing:

You need to review the charge master’s per day costs to identify duplicate billing.  This is not an uncommon error.  If two of the same lab tests, x-rays, doctor visits, physical therapy sessions, etc., were billed out on the same day, these are duplicate charges and should be removed from your bill.

 

Unbundling:

If you required x-rays, be sure to look at the description of the charges, especially if the x-rays were done in the same location. For example, if three separate charges are identified on the charge master for the knee, the x-ray should have been billed out as knee, three views, instead of listing each x-ray separately.

Also, scrutinize your lab tests. If you see charges for blood work that sound similar and charged out separately, it is possible that the charges should have been billed out as one test. For example, if there is a charge for white blood cell count and red blood cell count, this test should be charged as a complete blood cell test.

As another example, if there is a charge for blood work that specifies "without" and another charge for the same test indicating "with", the "without" test should not be billed. 

Medications:

Although duplicate charges are more difficult to identify in this category, a good rule of thumb to go by is to identify medications that are listed one right after the other. For example, if you received Demerol every four hours, and a charge for this medication is listed consecutively, it very well might be a duplicate charge.

For pills, look to see if the pills are generic or brand names. If the hospital gave you the brand name, this is more expensive than the generic. You should ask the hospital if the pills were available in generic form. You can also call your pharmacy and ask if a generic is available for the pills you received. If generic is available, you should ask the hospital why the generic wasn’t offered and dispute the charges for brand name prescription drugs.

Comparison:

Lastly, though extremely important, after you have identified these types of charges, request a new itemization (charge master) and compare it to the old one.  Make sure all the charges for items that were not removed or changed are the same, ensuring that the hospital did not simply allocate the charges into a different category.

Depending on the amount of your bill, combined with the amount of errors you found, you should be able to determine if you should hire a hospital bill review company to audit your bill.  If you are a layperson and were able to identify a multitude of errors, it may be worth the cost of hiring a hospital bill review company that will audit your bill.

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