Will Upcoding Ever End?

stethoscope-moneyAccording to a recent Wall Street Journal article highlighting the personal experiences of a doctor and lawyer who took his son in for a non-emergency CT scan, the answer would probably be ‘not anytime soon.’ The piece is an excellent example of what TPAs see every day.

Analyzing hospital bills and advocating for the member and plan are part of the services we provide, so it comes as no surprise to learn that, in this example, the hospital charged $20,000 for a service that should have cost no more than $10,000.

In the article, “Healthcare and the $20,000 Bruise”, the author outlines several ‘easy’ steps to fighting an outrageous hospital bill. A few of these include…

  • Be a doctor or nurse, then learn about upcoding
  • Have the legal knowledge to know when you are being lied to
  • Have the resources to pay huge bills upfront while waiting months for corrected billing
  • Understand that only the billing department decides what is to be billed
  • Have combined medical/legal knowledge to understand the implications of the coders’ rules

We’d like to add one more step as an alternative to those outlined above –

Look to your benefits administration professional to help you navigate these issues. We understand the healthcare system and can help you avoid unnecessary or inappropriate charges and expenses.


In cooperation with NAEBA

Follow @sip_tpa

Follow @the_NAEBA

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