A hospital bill review is a thorough examination of a patient's itemized hospital bill. Such an examination can uncover certain kinds of improper charges, but it cannot determine whether each item for which there is a charge was actually provided to the patient, was ordered by a physician and was consistent with the physician's diagnosis and overall treatment plan. Nor can a hospital bill review determine conclusively that any charge is improper.

The only way to make those kinds of determinations is to compare the charges in the patient's itemized bill with the information contained in the patient's medical records. Such a comparison is called a hospital bill audit. Auditing hospital bills is what we do.

When we finish auditing a hospital bill, we prepare an audit findings report -- a list of charges whose accuracy or validity we dispute and our reasons for disputing the charges -- and send it to the hospital. The hospital is expected to respond to the audit findings report either by producing documentation substantiating the accuracy and validity of the disputed charges or by removing them from the bill. The accuracy and validity of a charge may not always be clear cut, so we generally have to negotiate with the hospital to determine the proper disposition of some of the disputed charges.

How important are the patient's medical records to the hospital bill auditing process? The itemized hospital bill reproduced below contains data from an actual bill with the identifying information removed. The patient was treated on an outpatient basis for dehydration following a severe episode of gastroenteritis, which the patient insisted was "ghastly enteritis." Study the bill for as long as you like. Without the patient's medical records, there is no way that you will ever know whether the patient was overcharged.

So, was the patient overcharged? Yes, he was. The medical records clearly show that he received only two liters of sodium chloride solution (SOL SOD CHL 1000ML), not the three liters for which he was charged. When that fact was brought to the attention of a clerk in the hospital's billing department, his bill was reduced.

If even this tiny bill contains a hidden overcharge, doesn't it make you wonder how many overcharges are hidden in larger bills? Experience indicates that at least ten percent of the average hospital bill of $10,000 or more is composed of overcharges. Those hidden overcharges can be found only by auditing the bill, which cannot be done without the patient's medical records.

How much do you spend on hospital bills of $10,000 or more over the course of a year? Why spend more than you have to? Having your bills audited won't cost you anything out of pocket and can only save you money.

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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

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