Medical bill error glossary

This glossary explains the medical-billing errors we check for — duplicate charges, code-pair bundling, upcoding, EOB-rejected charges, self-pay overcharges, and missing financial-assistance discounts — in plain English. Each term answers a common question about what the error is and how to spot it on your own hospital bill.

• What are duplicate charges on a medical bill?A duplicate charge is when the same service, item, or billing code appears more than once on your bill for the same date — so you are charged twice for one thing. It often happens by accident when systems re-enter a line, and it is one of the most common medical-billing errors to check for.
• What is code-pair bundling on a medical bill?Code-pair bundling is when two procedure codes that federal coding rules say should be billed together as one are instead billed separately, which can raise your total. Medicare's coding edits list specific code pairs that normally should not be reported on the same day for the same patient.
• What is upcoding on a medical bill?Upcoding is when a bill uses a code for a more expensive or more severe service than the care you actually received. Because the code drives the price, an inflated code inflates the charge. Comparing the codes on your itemized bill to what happened in your visit can reveal a mismatch.
• What are EOB-rejected charges on a medical bill?An EOB-rejected charge is a line your insurer's Explanation of Benefits did not cover — denied, disallowed, or applied to a contractual adjustment — that a provider then still bills to you. Your EOB is not a bill; comparing it to the provider's bill shows which charges you may not actually owe.
• What are self-pay overcharges on a medical bill?A self-pay overcharge is when an uninsured or cash-paying patient is billed more than a hospital's posted standard or discounted cash price for the same service. Federal price-transparency rules require hospitals to publish these prices, so you can compare what you were billed against what the hospital says the service should cost.
• What are missing financial-assistance discounts on a medical bill?A missing financial-assistance discount is when you qualified for a hospital's charity-care or financial-assistance program but the discount was never applied to your bill. Nonprofit hospitals must maintain a written financial-assistance policy, and patients are often billed full charges without being screened for the help they were eligible to receive.

Want to know what the law says where you live? See our state-by-state guides to your medical billing rights.