The Role of Medical Billing Advocates in Healthcare

Healthcare billing is a challenging task, and its processes can get tricky. The complexity of medical billing services is more complex for patients unfamiliar with the complexities of the US healthcare system. The medical billing process can become overwhelming, time-consuming, and confusing; this can make for a frustrating experience for patients who try to understand the insurance claims or bills. That is where the medical billing advocates come to help.

Medical Billing Advocates – Who are they?

Medical billing advocates are specialists who work alongside patients to help them manage, understand, and negotiate medical bills with insurance providers. Billing advocates assist patients in understanding insurance claims and resolving billing disputes.

What Medical Billing Advocates Need?

What type of tools and information the billing advocates need to help you depends on your circumstances. These circumstances can revolve around your insurance plans or medical bills. Some medical billing advocates by state might have different requirements. Still, you may expect that billing advocates might need the following:

Your healthcare bills.
Patient insurance information, in addition to the details regarding any of the supplemental or secondary insurance coverage a patient might have.
Patient EOB forms (explanation of benefits)
Patients’ permission to let advocates speak with their healthcare and insurance providers.
Direct access to the patient’s medical records
Information regarding already made payments
A brief run-down of what steps the patient has taken to resolve the issues before getting the billing advocates involved.
Payment – Medical billing advocates do not work for free, but they will likely save you a lot more money on bills than advocates charge for their services

Duties and Working of Medical Billing Advocates of America

Medical billing advocates scrutinize medical bills for any errors, and these errors can present in many ways, including the following:

1. Billing for Medical Services Never Provided

Comparing medical records with billings can assist in revealing charges for products, treatments, supplies, or services that a patient did not receive. Common errors mostly happen when a biller confuses one patient with another. Such errors can also occur due to billers failing to review medical records thoroughly. For instance, billers might end up charging for a medicine prescribed by a doctor but never dispensed.

2. Duplication in Billing

Sometimes, billers include multiple/duplicating charges for services provided only one time. Duplicate billing is often a clerical error. While such mistakes occur innocently, their impact inflates medical bills.

3. Incorrect CPT Codes

Healthcare bills are primarily based on the CPT codes (Current Procedural Terminology). The CPT codes are assigned to every medical procedure or service. The use of wrong codes can result in claim denials from insurance providers. Furthermore, incorrect codes can result in overcharges from hospitals and other providers.

4. Incorrect Diagnostic Code

Healthcare billers review a patient’s medical records to determine health conditions that were treated. When a biller uses the wrong ICD code, it might not match the treatment mentioned in the patients’ bills. Any dissimilarity in CPT and ICD codes can result in claim denials from insurance providers.

5. Unbundling of Medical Services

When doctors or physicians perform two separate procedures or services simultaneously for the same patient, a comprehensive CPT code often signifies both procedures. The charge for such codes is less than the charges of CPT codes denoting separate procedures. This is because it takes physicians less time to perform two procedures than separately, at different times. In some instances, healthcare billers can improperly unbundle such charges by using separate codes instead of a code that describes a comprehensive procedure. Such instances are called unbundling of medical services, which can lead to overbilling.
Primarily, the billing errors result from honest mistakes of medical billers or coders. These errors result from inattention or poor training on the part of healthcare billing personnel.

In Summary

Medical billing advocates alongside patients to help them manage, understand, negotiate, and reduce their medical bills. Billing advocates can help when a patient has a lot of bills, a complicated medical situation, or even insufficient health insurance coverage. Billing advocates offer their services with an hourly fee or even for a percentage of the amount by which they get bills reduced. Sometimes, employers also provide medical billing advocacy as a plus of their benefits package.

Hospital bills
Doctor bills
Laboratory bills

The Role of Medical Billing Advocates in Healthcare

Medical Billing Advocates – Who are they?

What Medical Billing Advocates Need?

Duties and Working of Medical Billing Advocates of America

1. Billing for Medical Services Never Provided

2. Duplication in Billing

3. Incorrect CPT Codes

4. Incorrect Diagnostic Code

5. Unbundling of Medical Services

In Summary

Frequently Asked Questions

What are the uses of medical billing?

What is a medical billing summary?

Do medical billing advocates help with different types of medical bills?