Medical Billing Errors: What can go wrong? What can you do? - 6 -Billing begins

Medical Billing Errors: What can go wrong? What can you do? - 5 - Compiling the bill

Step 5: Billing begins

More than 30 people could be involved in this final stage, which begins with the hospital transforming the medical record into a universal bill that it submits as a claim to the insurance company. This stage ends with a patient receiving a bill for the balance. There are twists and turns along the way that can cause delays and denials.

Final review

At this point, technology begins to take a lead role. An electronic universal bill is complete. The hospital's computer system processes the bill to clear the insurance company's payment systems and automatically generates a statement to the patient that shows the treatment and services provided. This is not a bill. It simply lists the treatment received.

Medical Billing Errors: What can go wrong? What can you do? - 5 - Compiling the bill

Medical Billing Errors: What can go wrong? What can you do? - 4 - The inpatient stay


Step 4: Compiling the bill

About a dozen people work in the first stage of actually compiling the document that becomes the bill. Hospital staff collect the medical chart, often paper, to scan and merge it with the existing electronic record. The result is an electronic medical record with hundreds -- perhaps thousands -- of entries for people to assign codes for billing purposes. All of the text is summarized in codes -- the universal language of medical billing.

Chart collection

Medical Billing Errors: What can go wrong? What can you do? - 4 - The inpatient stay

Medical Billing Errors: What can go wrong? What can you do? - 3

Step 3: The inpatient stay

Dozens of people every day could provide care or services at this stage, when a patient is moved to an inpatient room. This is a labor-intensive stage that typically lasts about four days. In addition to medical care, there's an important, ongoing behind-the-scenes discussion among hospital and insurance company employees regarding the patient's condition and the medical treatment being provided. Post-operative complications, such as an infection or the need for follow-up surgery, can lengthen a patient's time in the hospital and vastly increase the number of hospital staff involved.

Room transfer

Medical Billing Errors: What can go wrong? What can you do? - 3

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

What can go wrong?

During the surgery, each staff member who enters a note on the chart must ensure the notations are mistake-free, complete and tell a story. Any missing or excessive detail on treatment provided can change the meaning of what was done and therefore affect the bill.

If a doctor's or nurse's notes do not convey the most correct and complete medical information, the insurance company may question whether the treatment was medically necessary. In addition, these notes

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.

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

Medical Billing Errors: What can go wrong? What can you do?

Step 1: The bill's inception

Roughly two dozen people might take action in this stage of the process. It begins

when a patient and surgeon pick a hospital, usually based on where the doctor has privileges, the patient's insurance coverage and the hospital's reputation. Once a surgery date is set, hospital staff begin gathering information about the patient and insurance coverage. This stage ends about a week before the surgery when the patient undergoes medical tests in final preparation for surgery.

The referral

The first information about the patient is entered into the hospital's computer system.

• A surgeon calls the hospital to schedule surgery.

Medical Billing Errors: What can go wrong? What can you do?

CLEVELAND, Ohio -- There are lots of places where something can go wrong with your hospital bill. By our count, 289 of them.

That's how many people who can play a part in creating a bill before, during and after a hospital stay.

There are the intake workers who take information, doctors and nurses who record treatment on a chart, coders who use those notations to assign billing codes, and many others along the way.