How it Works

By: Doris Goodbody


If you are unfortunate enough to go the the emergency room or even worse being a direct admit to the hospital not much happens at first. In fact no charges occur until you are seen by a physician or a nurse practitioner or a physician's assistant. The treatment starts the same time as the charges.

So once you are seen by a physician and treatment is begun, so begin the charges. Those items you see on your bill can only occur with a physician's order. The IV fluid, the x-ray, the lab draws only originate from a doctor's order. Even the crutches or dressing supplies come from a doctor's order.

As you might imagine there is more to it than that. I have presented a very simplistic view. And before long I will contradict myself about some of the things I said earlier. And that doesn't account for Medicare in the mix which complicates things further. But all that is for much later.

Back to the here and now, once the physician writes the order it is placed in the computer. If a lab test was ordered it will specify what kind of test and maybe even if the venipuncture is to be done by a phlebotomist or a nurse.

The computer will hold the order details for all orders. So if an x-ray is ordered in the computer it will have if it is portable or not and which site is to be x-rayed.

From personal experience I can tell you that personnel from both radiology and lab will ask "is the order in the computer"? And rightly so, the radiology technician and all the lab personnel involved want to be paid. The order that was generated by the computer entry will be billed to the patient to pay for the service performed.

If you have looked at a hospital bill lately you will not see any charges for nursing services. That is because nursing care is included in the cost of the room, the ED room or the ICU room or the cath lab room.

Anyway, that pretty much describes billing for services, no matter if the service is a lab test, x-rays, dietary, respiratory treatments, physical therapy or occupational therapy. Even consultations for another physician's opinion, such as a surgeon or gastroenterologist are put into the computer.

However, for supplies charges are done differently. I have seen a couple of systems and i am sure there are more. It could be a sticker from the time is placed on a patient's charge card. Or I have also used a hand held scanner that is used to scan the bar code of an item used.

So the patient is billed for the item is used. As you might guess this is a very simple way of looking at this. This doesn't include routine versus ancillary services. In this article though this is the basic approach and is used quite frequently.

From what I have explained it seems like a simple system. But as we continue our look at hospital billing errors and overcharges this simple system becomes incredibly complex.

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