Stop Hospital Overcharges 

Billing errors can't be that big a deal, don't they occur to both the hospital and patient canceling each other out?

According to studies by Equifax, the likelihood of an error on a hospital bill is 9 out of 10 times.

According to the National Health Care Anti-Fraud Association there is $51 BILLION per year in fraud alone, this does not include numerous overcharges. Do you want your overcharges added to that total?

How do errors occur on my bill?

Errors occur in many different ways. The most common probably is human error - transposing a number, adding an extra zero or a mistaken key stroke.

Additionally, the Billing code may be in error. Each procedure done in the hospital is coded using very strict guidelines established by the government. A new coder may unintentionally code the wrong procedure, as noted above, or the coder may commit fraud and "up code" for a larger payment from the insurance carrier.

The difference in a single digit of a code can result in hundreds if not thousands of dollars in overcharges. If the code is incorrect, a patient (or paying entity) will suffer.

Also errors on bills may occur if a charge is placed on the bill which was not ordered by a physician. Tests, procedures and other diagnostic tools or equipment not ordered by a physician or Nurse Practitioner or Physicians Assistant can not be charged.

Aren't the costs for supplies and services the same for everyone?

No! Medical care charges are dictated by the Chargemaster of the hospital. This is a list of all services, items and supplies available in the hospital. As you might imagine this is highly secretive and is changed often. Most times that price is inflated over the cost of the item.

Medicare is the largest payer of medical services in the United States. The US Government has done an extensive analysis of the cost of nearly every medical service in every locale across the entire United States, and they have determined a payment for that service.

Nationwide, Medicare will reimburse anywhere from 1.7% to 12% OVER the actual cost of the procedure.

Individuals without insurance may be charged the highest Chargemaster rates. The same holds true for auto accident victims since the "at fault" person's insurance carrier will pay the bills.

People with health insurance will pay a specified amount as per their contract with each hospital. As a result, the hospital may have an infinite pricing structure depending upon who the patient is.

We are self insured and our TPA does all that for us, why would we need your service?

Third Party Administrators, or TPAs, may have the responsibility to review some claims however, due to the number of claims they handle, as well as the specialized skills necessary to review claims fully, TPAs rarely do in-depth audits.