Medical Billing Errors: What can go wrong? What can you do? - 2 - The surgery stage

Medical Billing Errors: What can go wrong? What can you do? - 1 - The bill's inception

Step 2: The surgery stage

More than two dozen people may take action at this stage. A patient checks into the hospital, signs release forms, is prepped for surgery, undergoes surgery and is moved to recovery. This is a critical stage in the patient's treatment and the evolution of a hospital bill.

Registration

The patient arrives at the hospital and checks in at the registration desk.

• A person working on the registration desk goes over what's in the hospital's computer system to make sure personal and insurance information is accurate. Then a hospital employee brings the patient consent forms to sign and confirms surgery and inpatient stay information.

Surgery preparation

The patient is taken into a surgery-preparation area. Here, as in all the stages of medical care that follow, nearly everyone who deals with the patient will record their activities on a paper or electronic chart. Those notes -- hundreds, perhaps thousands, of lines of entries -- will eventually be used to create the bill.

• Medical treatment begins with at least one nurse doing an assessment to make sure that the patient's condition hasn't changed since the pre-assessment tests. An anesthesiologist and an assistant will evaluate the patient's health and begin preparation to put the patient to sleep.Meanwhile, the surgeon, and residents begin their prep while nurses, technicians and a physician's assistant prepare the patient, often shaving a part of the body, attaching monitors, inserting a catheter, checking vital signs, and starting an IV to administer fluids and medications.

Surgery

While the number of doctors, nurses and technicians varies per surgery, health system administrators estimate that typically almost seven people may be in the operating room.

• The surgeon performs the operation and, like the anesthesiologist and the anesthesiologist's assistant, often bills patients separately unless the surgeon is employed by the hospital. They all record their actions and the equipment used on the patient's chart, which becomes part of the bill. In addition, medication dispensed by additional clinical staff -- often a couple of nurses and technicians -- will be included in the hospital bill.

Recovery

The patient is typically moved to a recovery room, known as a post-anesthesia care unit, to safely regain consciousness and receive post-operative care. This will have its own charge on the bill. The patient is closely monitored, with frequent checks of pulse, blood pressure, temperature and blood oxygen levels. Hospital staff such as nurses, technicians and desk workers who attend to the patient must note time spent in the recovery room (the charge increases as the time increases) and treatment provided.

• The patient's care is primarily in the hands of up to three main nurses, depending on shift changes. In addition, a unit staff person at the desk is usually responsible for organizing and monitoring the patient's care even though the patient may never see or speak to this person. In the hospital pharmacy, a pharmacist and technicians dispense and record medication.

• As recovery progresses, the patient's condition is checked by the anesthesiologist, the surgeon and often, in a teaching hospital, residents, all of whom may visit in person.