Some of us could audit medical bills

Discussion in 'Fibromyalgia Main Forum' started by TXFMmom, Oct 5, 2008.

  1. TXFMmom

    TXFMmom New Member

    I know all of us have days where we can't read and retain anything. I had an almost photographic memory and now I cannot remember a telephone number which is read to me by an operator.

    However, I recently reviewed a medical bill for a friend, and I found $15,000 worth of overpayment on the first try. That was without having the orders from the chart. She has filed for a copy of just the orders and nursing notes for procedures records, instead of the whole thing, and I may well be able to uncover many more charges.

    I did have to get a waiver from her, and send it to the hospital to ask about some codes, but it only took me about 45 minutes on the phone.

    When I first became disabled with this DD I did some work in this type of thing, along with some other medico-legal work to keep my mind working. I would be the first to admit that some days, I wouldn't be able to do this, period, but if one did it on a small consulting basis, one could spend an hour or so a day on it, or when one has a good day, and it would be particularly good for ex nurses or coding clerks.

    Sometimes, it is best to get someone who has been a coder and a nurse together to audit the chart.

    My friend's insurance company has a program whereby they will split 50/50 with the insured on any overpayments which are identified. My friend is ecstatic, needless to say. This may well be something one could do and stay under the SS money, and it would be something one could do in a small way to keep the old mind working and make some money on the side.
  2. quanked

    quanked Member

    What is the 50/50 split? I really do not think I could do this kind of work as I find it hard to focus on much of anything a good deal of the time. I agree with you though--this kind of work would be useful in helping one to maintain a working a brain.
  3. TXFMmom

    TXFMmom New Member

    The insurance company gives the individual or covered individual 50% of what they identify as being billed incorrectly and is recovered from the hospital, physician, etc.

    If they identify $15,000 in overbilling, then the covered individual gets $7,500 back from the insurance company. Imagine that. When the individual has someone do the audit for them, as I am suggesting that many of us may be able to do on a limited basis, then they usually split their part 50/50 with the auditor. That would still mean that they would get back $3,750!!!!!!!!!!!!

    Everyone who has to be hospitalized for any length of time, and even for outpatient care should demand and go over their bill. I have never gone over an itemized bill and not discovered at least 20% overbilling. I am serious. On an outpatient bill I had, I discovered that they overcharged and charged things twice and even three times, and it came to $4,500.
  4. SpecialK82

    SpecialK82 New Member

    for letting us know! Does the hospital have to provide you with your chart/orders if you request it?

    With all the abbreviations and such on bills I wasn't sure that you could really track through everything item by item.

    Good job on saving all that money - errors probably happen all the time!!