By Debi Binkley, Bose McKinney Evans LLP
On July 9, Christine Kraft of MedReview Solutions presented an in-depth review of the importance of analysis of medical bills and their impact on cases involving both plaintiff and defense attorneys, with particular relevance to personal injury, medical malpractice attorneys and estate attorneys.
Kraft summarized what you need for an in-depth review. She outlined the cost of medical records as mandated by the state. She discussed two critical forms which should be obtained and reviewed – the Universal Bill “UB-04” and the HCFA 1500.
The UB-04 is the red-ink on white paper standard claim form used by institutional providers for claim billing. It was developed by Centers for Medicare and Medicaid (CMS) and has become the standard form used by all insurance carriers. The UB-04 data is applicable to every patient’s account regardless of payer status. Under HIPAA regulations, it is a patient’s and payer’s right to obtain this and all financial information pertaining to a personal account for which payment is expected. Kraft explained that under HIPAA, not providing a UB-04 is a violation as it is part of the designated record set as defined by HIPAA.
The HCFA 1500 is the official standard form used by physicians and other providers when submitting bills/claims for reimbursement to Medicare or Medicaid for health services. It is also used by private insurers and managed care plans. The HCFA 1500 contains patient demographics, diagnostic codes, CPT-HCPCA codes, diagnosis codes and units.
Kraft’s presentation discussed medical billing basics and the role of Medicare, hospital inpatient versus outpatient costs and physician billing. She also discussed uninsured versus underinsured. She addressed the issue of “sticker price” billing with a comparison of charges versus payment. She presented a number of case studies that revealed billing errors, questionable charges, red flags, physician or hospital billing errors, overcharges for single or multiple doctors and/or single or multiple procedures, charges versus costs and fair and reasonable reimbursement. She demonstrated examples of hospital and/or physician comparative analyses and how one hospital or physician might compare to others with overcharges, charge versus cost, etc.
Kraft emphasized the importance of looking to your medical bills for clues to your case, which are usually contained in errors and overcharges. She emphasized the importance of reviewing the UB-04, the itemized bill, HCFA 1500 and the medical records. Lastly, she emphasized the importance of understanding the difference between cost versus charge, charge versus payment, and how those charges compare to other providers.
Kraft’s presentation addressed her role as medical bill consultant in helping to eliminate billing errors, provide an opinion as to a fair and reasonable reimbursement, and compare charges to other providers for identical services. She emphasized that her role was not to address medical necessity. Kraft clearly demonstrated that consulting a medical bill reviewer can bring value to your case.
For more details regarding Kraft’s presentation or to make arrangements to view the video of the seminar, contact the Indianapolis Bar Association at email@example.com .
Christine Kraft has worked as a consultant for both hospitals and physician practices, performing financial analysis and advising clients on cost reduction and business planning techniques. Since 2005, she has analyzed medical bills for consumers, third party administrators and Taft Hartley Funds; with a focus on working with attorneys. She has spoken at local support group meetings on Medical Bill Management and has been a presenter on Hospital Cost Reporting at Medical Billing Advocates of America’s National Conference. She holds a Bachelor's degree in Marketing from Indiana University and successfully completed the Certified Public Accountant exam in 1992. Kraft was determined to be an "expert" in the field of medical billing by the Court of Appeals of Indiana (July 2011) under the name of "Christine Lewis". (Jackson vs. Trancik, Hamilton Superior Court, Indiana, No. 29D02-0911-CC-1421, Chief Judge Margaret G. Robb, Court of Appeals of Indiana) Kraft can be contacted at 317.430.3196 or firstname.lastname@example.org .