Patient Advocacy: The Other Half of the Medical Billing Coin

by  Find-A-Code™
Feb 21st, 2023

When most people hear about medical billing, they think of things like diagnostic codes, HIPAA compliance, and the like. All such things apply to medical billers who spend their days poring over electronic health records and turning them into invoices they eventually send on to insurance carriers. Yet there is another side to medical billing that doesn't get a whole lot of attention. It involves patient advocacy.

The Boston Globe recently ran a piece profiling a Rhode Island woman who became a medical billing patient advocate after firsthand experience caring for an ill mother diagnosed with brain cancer. What she learned from that experience motivated her to become a certified patient advocate who specializes in billing issues.

Medical Billing Is Complicated

As a medical billing specialist yourself, you know that the billing process is complicated. Before you ever see electronic health records, they have been handled by clinicians, office staff, and medical coders. Each party adds and modifies data according to their individual responsibilities. You are left to sort it out and create accurate invoices from it.

You must have a thorough understanding of ICD-10 codes. You need to know about ICD-11, CPT, and NPI lookup. The amount of knowledge and experience it takes to be a competent medical biller takes time to acquire. Common sense dictates that the average patient staring at a medical bill they do not understand also does not have that knowledge and experience.

That's where medical billing patient advocates come in. These are professionals who are trained in patient advocacy and billing practices. While there are exceptions to the rule, most have at least some medical billing experience before becoming certified patient advocates. That gives them the ability to go through bills with patients for the purposes of figuring out why they are so high.

Mistakes Are Made

The patient advocate's job is not to help patients skip out on legitimate bills. It is not to help patients game the system. Rather, a medical billing patient advocate assists patients in understanding their medical bills and, where appropriate, contesting mistakes so that patients do not pay more than they owe.

Let's face it, mistakes are made in both medical coding and billing. One of the more common mistakes is assigning the wrong code because a clinician was not clear in their records. The wrong code could mean a difference of hundreds, or even thousands of dollars.

There are also those occasions when multiple codes could apply. But depending on a patient's health insurance coverage, using certain codes could result in a denial of payment. It's imperative that clinicians, coders, and billers choose the right codes.

Duplicate Charges Are Also a Reality

Another thing medical billing patient advocates frequently uncover are duplicate charges. With so many hands in the proverbial pie, this particular issue should not be surprising to any medical biller. Electronic health records and medical bills can cross paths many times between actual treatment and payment. All the back and forth creates multiple opportunities for duplicate charges.

A patient advocate knows enough to request itemized bills from healthcare providers. They know enough to go through those bills in search of duplicate charges. Patients do not necessarily know to do so. And even when they do, they often don't understand what it is they are looking at.

One side of the medical billing coin involves preparing the bills that are ultimately sent to insurance carriers. The other side involves going through those bills with patients. Both sides of the coin create a more complete picture of everything that medical billing entails.