Payment Integrity
October 7, 2022

What is Claim Editing & How Can It Benefit You?

3 minute read
A frustrated patient in a wheelchair and arm sling tries to make sense of a medical bill, highlighting the importance of claim editing

Did you know that billing errors are shockingly common in the medical reimbursement process? Unfortunately, as much as 80% of all medical bills contain some kind of error. The healthcare industry likes to present a meticulous, professional appearance that projects a sense of authority to patients whose lives they may hold in their actual hands. However, like any other business office, every team has weaknesses and some simply fail to verify they’re charging patients the proper amounts.

Such mistakes can be costly, especially for more extensive medical procedures. But why do such errors occur in the first place, and what can you do to prevent them from happening to you?

Claim editing is a practice designed to prevent patients from paying more for medical bills than they should. This blog will discuss claim editing and how it can benefit patients.

Why are Billing Errors So Common?

Whether they are aware or not, most patients have had some experience with medical billing errors. For example, when a patient undergoes a medical procedure that involves an extended hospital stay, doctors use a variety of resources in differing amounts to perform the surgery and keep the patient in good health throughout recovery. During this hospital stay, providers will perform multiple treatments using an array of pharmaceutical drugs, medical supplies, and equipment like saline drips, gloves, and masks.

Ultimately, the hospital charges patients for all services, supplies, and equipment—including the hospital room—required for a successful procedure. When patients later receive an itemized bill, they will most likely pay the full amount without scrutiny, particularly if they’ve undergone a life-saving procedure that reinforces the perception of physicians as authority figures.

However, patients could be paying hundreds or thousands of dollars in unnecessary medical payments due to errors or inconsistencies in the billing process. But what causes such widespread problems? Some sources of billing errors include:

  • Coding errors: The standard tracking method for medical services is by code. This complex system matches treatments and services with symptoms; when the wrong codes are used or if digits in the code are transposed, errors can occur. Some of these errors are due to clerical oversight while others are the result of profit incentives.
  • Duplicate charges: Being charged more than once for a service like taking your vitals, or receiving multiple charges for post-operative pain medication like tramadol, is also extremely common. These duplicate charges can easily add up and inflate the total cost of medical bills.
  • Network errors: Private insurance companies use a dizzying number of networks, each one with different discounts and co-payments. If medical providers charge insurance companies and patients incorrect rates, it can also cause errors. This is not unlike the time your phone carrier forgot to bundle your streaming subscription with your monthly plan and charged you an extra $50.
  • Upcoding: Hospitals may “upcode,” or increase the price of services or resources, to compensate for their assumed intensity of care and need for resources. However, this often only results in increased profits and not a backup supply of vital equipment.

As you can see, a significant margin of error exists in a process as convoluted as medical reimbursement. Thankfully, there is a way to combat these common errors.

What is Claim Editing & How Can It Benefit You?

Claim editing, one of many cost containment solutions, occurs during the healthcare reimbursement process to ensure the accuracy of items listed on a medical bill. This protects the patient from overpaying for services or paying for things that should not have been billed in the first place.

One effective claim editing method is a clean claim review. This pre-payment process leverages powerful software and expert clinical reviews to ensure claims are free from errors or inconsistencies that the client would otherwise pay. 

Because clean claim reviews evaluate every line item billed to ensure consistency, they can deliver exceptional savings. In addition, the process serves as a reliable measure of enforcing payment integrity in healthcare at a time when levels of transparency and integrity in the industry are critically low.

Instead of settling for the opaque practices of traditional medical billing, claim editing strategies like clean claim reviews can protect patients from being gouged by outrageous billing practices.

6 Degrees Health Offers Expert Claims Editing

Because 6 Degrees Health was founded by healthcare industry veterans, we know the ins and outs of the medical field and the healthcare reimbursement process. We started with the goal of helping patients and their employers navigate the turbulent waters of healthcare; we not only help them save money but also help them to better understand the language of the industry.

By working directly with third-party administrators and brokers, our clean claim review process is a step above other claim editing practices. Backed by our proprietary software and industry expertise, our cost containment model can help you save up to 40% on your healthcare spend so you can realize the true value of quality healthcare.

Interested in learning more about claim editing? Speak to a representative today to find out how our reference-based pricing model can help you realize the true benefits of healthcare.


Looking To Lower Your Company Healthcare Coverage Cost?

As a service-first cost containment company, 6 Degrees Health is here to help employers and employees navigate a historically opaque healthcare system to pay only what is fair.

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