Any itemized charge that is not substantiated by documentation in the patient's medical records is likely to be an error and must be treated as an error unless the hospital can demonstrate otherwise.

The following kinds of charges are almost always erroneous overcharges:

•  Charges for medications and supplies that a physician did not order or that the patient did not receive.

•  Charges for tests and services that a physician did not order or that were not performed or provided.

•  Charges for certain services that were performed by nurses or technicians, such as equipment monitoring, that should be included in the room charge.

•  Separate charges for tests that together comprise a panel for which there should be a single charge.

•  Charges for equipment monitoring services on occasions when the equipment in question was not in use.

•  Separate charges for services and supplies that should be included in the charge for another item.

•  Charges for items dated before the patient was admitted to the hospital or after the patient was discharged from the hospital.

•  Duplicate charges (i.e., more than one charge for the same item).

•  Charges for tests and services that had to be performed a second time because they were performed incorrectly the first time, because the results were lost or mislaid or because of some other hospital mistake.

•  Single charges for items that should not be lumped together in a single charge.

•  Charges for improperly identified or unidentified items.

•  Charges for personal items, such as a toothbrush, a comb or slippers, that the patient did not use.

•  Charges for services that the patient refused.

•  Charges for routine supplies such as urinals, bedpans, irrigation solutions, ice bags, IV tubing, pillows, towels, gauze, oxygen masks, oxygen supplies and syringes.

•  Charges for routine supplies used by hospital staff, such as surgical gloves, coats, drapes and masks.

•  Charges for routine equipment such as blood pressure cuffs, heating pads and thermometers.

•  Room charges that were incorrectly calculated, such as if the patient had a semi-private room but was charged for a private room; the patient requested a semi-private room but was placed in--and charged for--a private room because no semi-private room was available; the patient was charged for a greater number of days in a specialized unit like intensive care or cardiac care than he or she actually spent there; or the patient was charged for a room on the day he or she was discharged from the hospital.

•  Charges that are not allowed by the Health Care Financing Administration or by an appropriate state agency.

•  Charges for services that are completely inappropriate, such as a woman being charged for a circumcision or a man being charged for a hysterectomy.

•  Charges that are incorrect because of data entry errors.

Questions of medical necessity are generally not addressed during a hospital bill audit. Neither are most questions involving diagnosis, course of treatment, choice of medications and so forth.

Coding is another matter that is rarely investigated during a hospital bill audit. Most large hospital bills are for inpatient services. Hospitals are not required to use CPT codes for inpatient services, so they generally use their own unique services codes. Those unique codes do not readily lend themselves to auditing.

As hospital bill auditors, we're thoroughly familiar with the kinds of errors that hospital bills contain. If you haven't already visited our home page and the rest of our site, please do so. Then put us to work on your hospital bills and watch us save you money.

Home Page

How Our Service Works

Hospital Billing Practices

The Kinds of Errors Hospital Bills Contain

Games Hospitals Play

ERISA and Hospital Bill Auditing

Third Party Administrators

The Importance of Medical Records

Our Position on Hospital Audit Policies

A Few of Our Success Stories