August 03, 2020
Medical Bill Auditing


Medical bill auditing is important in situations where you have extensive medical treatment, such as that involved with an extended hospital stay. With numerous medical personnel attending to your treatment and care, there are bound to be mistakes made in properly recording the services you received and the medical supplies used. Auditing your medical bills basically involves comparing the record of your treatment to the itemized bill to determine that treatment and supplies were delivered to you as charged.

Where to Start?  The scrutiny isn't easy. Even a short stay in the hospital can result in a multipage bill. Hospital bills also have a language all their own, so often you won't recognize even legitimate charges on first glance. Consumers can also be hampered because they don't remember exactly which procedures were done and which drugs were administered at particular times. After all, the person receiving the treatment was sick, sometimes unconscious.


Ideally, if you know you are going to the hospital, you should think about checking in with a notebook. Then as services are being provided, write them down, including drug dosages and times.

Of course, this isn't always practical or possible. Patients who are on heavy medication or are in for serious operations are frequently not in a position to take notes. But if you are-or when you are-up to it, start paying attention.

Request Your Bills

For most people, though, the auditing process will begin after they get out of the hospital.To begin the auditing process, you should request copies of bills from both your hospital and the insurance company. The form known as a UB-04 should be requested in the case of a hospital or other facility because it is the complete, itemized charges incurred during the stay rather than a summary by category. This will give you the complete documents needed to check for errors.

Your first step should be to make a copy (or two) of that bill and start highlighting or circling items that you don't understand or services you can't recall.Then spend some time trying to retrace the experience. Obviously, if you have a written record this will be much easier. But even without it, it's possible that reflection will cause you to recall that some of the questioned items were legitimate.
It should adequately itemize all the charges for services provided and supplies used in the course of your medical treatment. Don't rely on the first bill you receive from the hospital as being a complete bill for your stay. More bills are likely to come directly from service providers used by the hospital.
Review Your Bills  Compare the itemized bill to your inpatient progress notes to verify that the charges for your treatment on the bill match the treatment that was ordered by your doctor. In particular, note where your medical records indicate that your doctor changed or canceled certain treatment or medication, to ensure that these items were not included on your bill.
In addition to the medical bill, you will also get an explanation of benefits (EOB) from your health insurance company, if you have one.   Compare the two documents to make sure each has matching charges.  If they match, but you believe the bill is too much, then contact the hospital or clinic.  If the EOB doesn’t match the bill, then your insurance company may be overcharging you.  If you have a co-pay, this will not matter much to you since you are paying a flat fee regardless, but if you have a co-insurance, you are paying a percentage of the services and will want to keep the total cost of care as low as you can.
Other charges might require a call to the hospital billing office for explanation. When a charge cannot be explained by reviewing your medical records and talking to your doctor, you obviously want to get it taken off your bill.
  • Check simple things first. Make sure the number of nights and dates of stay are correct. If you are charged for a special room, such as for a labor and delivery room, make sure you were there and that you weren't double-charged for another room at the same time.
  • Check your room classification. Sometimes hospitals will make the error of charging you for a private room when you were actually in a double. Check your room classification to avoid this mistake.
  • Check medication charges. Sometimes you will receive a generic drug, yet the hospital will charge you for a branded drug. This is a coding error that could be expensive.
  • Check for services that were canceled. If you doctor had planned on doing a service, and then canceled, make sure you aren't charged for this. Sometimes the billing charge won't get canceled.
  • Check Personal Supplies.the itemized bill for charges regarding personal supplies (e.g., robe, soap, toothbrush...etc.) that you did not use, especially if you brought these supplies with you in preparation for your stay. 
  • Check for central supply items (such as aspirin and cotton balls), lab tests and pharmaceutical supplies. Auditors maintain that these areas are most prone to error.
    If you find erroneous items, particularly expensive ones, be sure to contact your insurer.
  • Check
    the itemized bill for duplicate charges, particularly with regard to testing services. If a technician needed to redo a test because of his own mistake, you should not be charged twice to have the same test done.
  • Double check the number of days you spent in the hospital to ensure accuracy. Also, if the hospital charges you for the date of discharge, request this fee be waived. Most hospitals don't charge you for this day.

Contact the Provider If the error is on the facility bill, a simple call to the hospital asking to review the bill may clear things up quickly. Among larger clinics or hospitals, this is sometimes called an “internal audit”, and they have in-house auditors who are there to do this, so make use of them. If you notice different charges on your insurance explanation of benefits (EOB), you should call your insurance company to ask the reason for this difference.  It may be an error and easily corrected.

If the call doesn't clear things up, prepare a written list of the disputed charges and send it to the hospital, along with a written request that the hospital audit its bill in light of your list---and give a response to each item you listed. They are legally required to provide an answer to this request.

In the interim, check with your doctor whether the services in question on your bill were indeed requested for you.  You can’t be charged for a service that your physician didn’t order…in writing.  When your doctor orders treatments or services, they send them directly to the labs or other facilities where your treatment takes place.  Often times you will never see this order, so if you are unsure about a treatment, call your physician and ask that they confirm in your medical records  

If you are not able to resolve the charges in question by the time the medical bill is due, then you should consider paying the itemized charges you are not challenging. Some hospitals or clinics have 30-60-90 day notices, but it’s best to watch them closely.  After 60 days, if things are not resolved, your unpaid bill could be sent to collections, and this could hurt your credit score. If you suspect this of happening, run a credit report to see if your unpaid medical bills show up. If so, contact your credit card company to inform them of the dispute, which often will lead to them reviewing or even correcting the report.

If the audit fails to erase the disputed charges and you are still convinced that you've been overcharged, you might want to consider litigation against the hospital. Remember that courts typically require original documents so never give or send anyone your original bill.
 Related Resources: 

1. "Have You Reviewed Your Hospital Bill?",  Trisha Torrey, (April 7, 2009).

2. "8 Things You Must Do to Prevent Hospital Overcharges", Health Magazine (Jan 10, 2011).

Her delivery is a little much from a public speaking standpoint, but she makes some insightful points about how she learned the industry standards for calculating fair and reasonable charges.  It's an object lesson in medical bill auditing gleaned from the two years she spent "demysitifying" her hospital bill in order to find that she had been gouged for 800% profit!