The aftermath of an accident can leave a victim in their most vulnerable state. Sadly, some health facilities take advantage of patients’ vulnerability to engage in exploitative billing practices.

While the patient is protected from such abuse by universal rules and regulations, not many patients realize that a facility is violating those rules. That’s where a medical billing expert comes in.

So, Who is a Billing Expert?

A medical billing specialist is an important link between patients, doctors, and insurance providers. Their job is to review a patient’s treatment records and convert them to codes for billing purposes and record tracking. In other words, a billing expert makes sure that the dollar amounts charged are accurate, based on the services provided.

When getting medical care, it is critical that you first understand what is or is not covered by your insurer. This can help you avoid billing surprises. Besides knowing what is or is not covered by your insurer, it is also essential to have a clear understanding of the billing to ensure that you only get charged for the services you received.

Proper billing must follow “usual, reasonable, and customary” (URC) standards defined by the American Medical Association or the American Association of Nurse Life Care.

“If you have received a huge bill, you are entitled to file a lawsuit with the billing entity while you look into the fees,” says personal injury lawyer James Onder.

A Billing Expert Can Help

As a layperson, dissecting complex medical reports to identify what you were billed for can be complex, and you may need to request help from a billing expert. He or she can help your lawyer prepare the evidence required to succeed in your case.

First, a billing expert will help determine if you were incorrectly billed for services that were not actually provided. They’ll also ensure that the billing followed the proper coding. Improper coding is one of the main billing errors, and it can mean the difference between your insurance covering a cost and a big bill for you.

In addition, the billing expert can ensure that you were billed a reasonable cost fr services you did receive. The charges must fall within the 75^th to 80th percentile for the same services in other facilities in your geographical area.

A billing expert may not necessarily be a coding expert, so it is possible to have two types of experts working on a case. However, you will be better off working with an expert specializing in both fields to save costs.

Identifying Fraudulent Bills

We all want to trust medical facilities, but billing errors and fraud are rampant. Unfortunately, most patients are unaware that this problem exists and they don’t question their providers.

Medical bills can be inflated in several ways. One such method is intentionally offering services that are not covered by the insurer, and then asking you to pay out of pocket.

Intentional billing for services not covered by your insurer is a bad billing practice, and you have a right to challenge the billing in court.

If you are only suspicious of unfair billing and unsure if you should file a claim, there are several resources on the internet that you can use to determine if the billing method used was fraudulent. A good example is FairHealthConsumer.org, which offers free information about customary charges for specific services in a given zip code.

Qualifications for Billing Experts

There is no legal requirement for standard certification for a person to work as a billing or coding expert.

However, if you work with a qualified attorney to take a case to court, your billing expert will need to have obtained industry certification. Presenting evidence through a non-certified billing expert can be easily challenged in a court of law.

Bottom line: Medical billing errors, intentional or not, are far more common than most people realize. If you believe you may have a claim, contact an experienced attorney at OnderLaw. We will provide you with a no-obligation, free case review to give you peace of mind and, if you have a case, the justice you deserve.