Imagine paying for a treatment or medical service twice without even knowing about it. A billing mistake or scam can cost you thousands of dollars or even legal trouble. Sounds unfair, right?  What if your hospital bill mentions double costs for the procedures? It seems like medical billing is errorless, but in reality, many errors are involved. Double billing is the top of all.

Most often, people do not cross-check their medical bills in times of distress and unknowingly pay double the amount. Beware! This might just not be a mistake. It can be a fraud. It’s wrong, but it happens more often than you think. Double billing in medical billing is a significant issue that can create serious trouble for everyone involved in this process.

In this blog, we will discuss all important medical billing points so you can protect your money and licenses.

What is Double Billing in Medical Billing?

Double billing in medical billing is the practice of charging double the amount for the procedures, treatment, or medical services provided to patients. It may be a mistake, an intentional fraud, or a system error. Double billing causes serious financial loss for the patient or the insurance provider.

Double billing, if proven a fraud, has serious legal and financial consequences. The matter is addressed per federal and state legislation, resulting in significant offender penalties. There is a strict prohibition of fraudulent double-billing practices under the FCA(False Claims Act) and HIPAA(Health Insurance Portability and Accountability Act).

Common Causes of Double Billing in Medical Billing  

Double billing has multiple causes, from human errors to intentional scams.

Following are the details of all those causes.

A. Human errors 

Medical billing is a very complicated process involving a lot of steps. Human error is highly likely if performed quickly or in a hurry. Some common mistakes that happen during manual steps of medical billing include:

  1. Mistakenly entering the services cost twice in the patient’s records.
  2. Administrative errors occur when billing information is transferred between different departments.
  3. Submitting the same claim twice may happen due to a lack of coordination between the primary and secondary insurance. 

B. Electronic glitches 

With advancements in every field, medical billing has also taken a different arc. Multiple medical billing software applications create claims. Electronic health records (EHRs) and medical billing software are subjected to glitches that cause double billing. These technical glitches may cause double billing. Some system-related issues are listed below:

  1. Claim duplication by the software itself.
  2. Misconfiguration of the codes causes double the application of the charged amount.
  3. Errors linked with auto-generated bills that lead to duplicate submissions.

C. Fraudulent practices 

Sometimes, the double bill is a deliberate attempt to increase reimbursements from patients and insurance companies. The fraudulent tactics used for double billing include:

  1. Bill the insurance provider and the patient the total service amount for the same service separately.
  2. Charging a different insurance company the total or partial service cost separately, although a specific insurance company already reimburses the procedure.
  3. Using slightly different codes for claim submission to bypass the detection system.

D. Double billing due to lack of coordination between healthcare service providers:

In the same hospital setting, multiple doctors and healthcare professionals are treating multiple patients at once. If there is a lack of coordination between these professionals, they might charge the patient separately. It is very common for the same patient to be referred to several doctors on a single visit. Double billing is prevalent due to this kind of issue, so all patients should take special care of it. 

Consequences of Double Billing in Medical Billing: 

Even a single, double billing can lead to legal troubles, financial strains, and loss of credibility. The impact goes beyond the patient and service provider. These may also impact other stakeholders. 

Read the following paragraphs to learn how double billing can affect you.

  • Consequences for the Patients

If you are a patient, the main problems would include overpayment for services, increased and unexpected expenses, and difficulty in resolving the matter with hospital administration. 

  • Consequences for the insurance companies

There are two main complications related to insurance companies.

  • Over-reimbursement causes huge financial losses.
  • Unreal administrative workload for investigation of the solution. The insurance company has to investigate and check the paperwork to resolve this case of fraudulent claims.

  • Consequences for the healthcare providers

Healthcare providers are at the risk of losing their licenses and patient’s trust. Legal penalties of the False Claims Act may lead to heavy fines. The hospital and healthcare workers’ credibility becomes questionable, and they lose the trust of patients and the medical insurers. The people involved in this act are at high risk of investigation by federal agencies. 

How to Prevent Double Billing in Medical Billing?

Thoroughly reviewing your bills is essential for saving money and avoiding legal issues. Taking the initiative to cross-check them yourself is a smart and effective strategy. Read about the prevention techniques below:

  • Strong billing protocols

The administration of healthcare organizations that implement strong billing protocols like conducting regular internal audits, hiring trained billing specialists, and ensuring a proper coordinator between different departments and providers.

  • Advanced medical billing software

Automated and advanced billing software is less likely to cause a double billing error. Invest in buying strong billing software that can provide real-time claim tracking to prevent resubmissions. AI-powered anomaly detection to detect fraudulent billing patterns. Automated cross-check to detect duplicate charges.

  • Hiring trained staff on billing compliance

Training can help staff in managing unexpected errors smoothly. The hospital administration should encourage regular training in software and medical billing procedures. 

  • Other preventive techniques

A few other techniques for the prevention of double billing include:

  • Verify the patient’s insurance details before submitting the claims.
  • Sending claims to the primary insurer before sending those to the secondary insurer.
  • Educating patients about double billing. Encourage them to request itemized bills from the healthcare providers and compare their medical bills with ROB – Explanation of Benefits statements from insurance companies. 

Wrap Up

Double billing is a severe issue in medical billing. It can lead to many problems for the patients, care providers, and insurance companies. Taking a little extra care when processing medical bills can save you from a lot of trouble in the future. While double billing in medical billing is not always an attempt to scam people, and sometimes it is a genuine mistake, you should still be careful in playing your part in prevention.

Our I-Med Claims medical billing company ensures you don’t have to pay extra for your medical expenses. We love to educate people regarding their rights and prevalent scam activities. If you still have any queries, contact us.