How to Fight A Medical Bill

I had a client who called me, upset about a medical bill for lab work. The bill was over $1,000. I asked the client to bring the bill in so I could look at it for them. After reviewing the bill, the ICD-10 codes were wrong. After resubmitting the bill with the correct ICD-10 codes, the bill was $0. The client owed nothing.

If the client had not called me, I would not have had the opportunity to help her. The $1,000 bill would have been devastating to her family budget. Who wants to pay bills that are not owed? No one! That’s why it is so important to your mental, physical and financial well-being to understand ICD-10 codes and how they impact your medical bills.

An ICD-10 code is a code used in the International Classification of Diseases, 10th Revision. It is a standardized coding system used by healthcare providers and insurers to classify and code all diagnoses, symptoms, and procedures recorded in conjunction with hospital care in the United States and many other countries.

Purpose of ICD-10 Codes:

1. Diagnosis Tracking: ICD-10 codes allow healthcare providers to track and record diseases and health conditions.
2. Billing and Reimbursement: These codes are essential for processing health insurance claims for payment and reimbursement.
3. Research and Analytics: They facilitate the analysis of health data for research, quality improvement, and statistical purposes.
4. Regulatory Compliance: They ensure standardized reporting and are required for compliance with health information standards.

Impact on Medical Bills:

1. Insurance Claims: Accurate ICD-10 coding is crucial for insurance claims. Insurers use these codes to determine the reimbursement amount for the healthcare provider.
2. Billing Accuracy: Proper coding ensures that patients are billed correctly for the services they receive. Incorrect or missing codes can result in denied or delayed claims.
3. Coverage Determination: Insurers use ICD-10 codes to decide if a particular treatment or procedure is covered under the patient’s health plan.
4. Medical Necessity: The codes help in justifying the medical necessity of services provided, which is critical for getting approval and payment from insurers.

ICD-10 codes are integral to the healthcare billing process, affecting everything from claim approval and payment to the accuracy and timeliness of medical billing. Billing mistakes are common so it is important that you review each bill for accuracy, know what your diagnoses are and make sure billing is applied appropriately. If you have questions don’t hesitate to reach out to the agency billing department. You also can ask for an advocate to help you understand your bill. If you are still struggling, talk to your healthcare providers. They can advocate for you as well.

Blessings,

Heather

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