Decode Your Medical Bills

If you've been hospitalized, or just had an emergency room visit, you may now be in possession of a bill with a very high dollar amount attached. You might wonder why it costs so much, and how you can find out. It may be intimidating to try and figure it all out, but this is critical for you to know how to do so you can look for errors and overcharging. This article will go over how you can decode your medical bills, as well as how you make sure the charges are accurate.

Make Sure You Have the Correct Bill

The first step with any is to ensure it is a bill and not just a part of your bill. If you have health insurance, you may only get a partial statement. The only way for you to tell if the charges are correct is to check your itemized bill from the hospital. You will most likely get a paper statement in the mail, but more doctor's offices are going to electronic statements. Call your doctor and ask if you're not sure if you'll be getting a paper or electronic statement. Another option is for you to receive an explanation of benefits (EOB) from your insurance provider. This EOB will show you what your insurance paid for your hospital costs, and it will say that it is not a bill right on the paper.

Different Types of Bills

Small clinical errors slow down your billing process as well. Before you leave your doctor's office, double check that your name, address, dates of treatment, and insurance information is correct.

Summary Bill. When you get care either as an inpatient or an outpatient, you will most likely get a summary bill. This will have general charges, but not everything. This isn't the bill you want to double check your charges. There will be no codes and just have broad categories.
Itemized Bill. You will want a complete, itemized bill from any and all of your hospital visits. Also, make sure to ask that the medical provider to give you the medical codes along with your itemized statement. As soon as you have this statement, you're ready to look for any mistakes or overcharges.

Know What the Different Codes Are

Your bill will have several different categories of codes listed on your statement. These are for various portions of your hospital stay or visit, and they are listed below by category.

HCPCS Level II Codes. The HCPCS Level II Codes are used to keep track of any products or supplies that were used during your stay. They are also referred to as service codes, and they usually start with a letter and not a number.
ICD-10 Codes. ICD-10 Codes are referred to as diagnosis codes. These codes come from the International Classification of Diseases (ICD). In the United States, it is mandatory that every ICD-10 code corresponds to a service with a CPT code. This ensures that the treatment you received was medically necessary and correct.
Revenue Codes. A revenue code is used to tell which dollar amount is associated with a particular procedure. There are not universal revenue codes, and each on is specific to an individual facility. The revenue codes could also show up on your insurance's EOB.


The next step is to decode the medical jargon that your bill will be packed with. You can get a medical dictionary or search online to translate your bill into plain English. You can use the Medicare code lookup to check and HCPCS and CPT codes. Unless you have Medicare, ignore the prices. Finally, check an ICD Code reference site for any remaining questions.

Things to Look For

Now that you have all of the tools there are things you want to look for.

• You got all of the services on your bill, including medications. Even if you don't take them, you'll still be charged for them.
• Check for duplicate charges.
• For surgery, check for an operating room time. This is listed in minutes.
• You can understand each charge on your bill. If you have questions, you have a right to ask for them to be clarified.
• All of your charges add up to the total at the bottom of the bill.

If you've done all of the things that are listed above and your bill is correct, you get peace of mind. However, if the charges seem too high, call and ask to talk to someone at your physician's office. They may be able to negotiate a lower bill for you.

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