Your Medical Bill Doesn't Come from Thin Air

Everyone goes to the doctor for many different reasons from annual check-ups to sick visits. You visit the doctor then a week or so later a bill. The medical office bill must go through a process before it is sent to you or your insurance company.

As soon as you set the appointment the billing starts. The secretary puts the appointment into the medical office's computer. After she gets your insurance information; it is then checked to see if it is still current. When it clears the insurance company is told about your appointment at the practice. Your insurance company checks to see if the appointment can be covered and goes by the rules on your contract. Don't worry you are not officially charged until after service is rendered.

On the day of your appointment the secretary checks you in. this starts the official billing. An encounter form (also known as a superbill) is printed up. The encounter for is a long sheet with a check off list of test and procedures the practice does on the regular basis. Now service starts to be billed in.

When you see the doctor he asks you the reason for your visit. He writes your answers in your records. The doctor follows a S.O.A.P. system for your medical records. S.O.A.P. stands for:

S= Subjective Findings (How you feel and notice. Reason for why you came)

O= Objective Findings (What your doctor finds from examination, procedures and test)

A= Assessment (Diagnosis. What is your sickness?)

P= Plan (Prognosis-what is the progress of your sickness. The steps being taken to get rid of the sickness.)

In S.O.A.P. the "O" and "A" are used in constructing your bill. The objective findings usually have the procedures performed. The assessment has the diagnosis, which is also placed on the bill. The medical record sheet usually backs up what was written on or checked off on the encounter form.

That is how medical information is break down but may not appear that way on your records or the bill. The medical records are not designated simply in S.O.A.P. depending on the practitioner (doctor or nurse) but should follow that form mentally. The encounter form and bill has codes on it. Those codes are ICD-9-CM and CPT.

CPT stands for Current Procedural Terminology. CPT is used to code procedures like surgeries and blood test. American Medical Association (AMA) since 1966 publishes CPT. ICD-9-CM stands for International Classification of Diseases 9^th Revision Clinical Modification. ICD-9-CM is used to code diseases and external causes of sickness like poisoning. It is also used in hospitals for inpatient procedures. ICD-9-CM is published by World Health Organization (WHO) yearly since 1979. They use the codes so your medical information remains private.

Claim forms also have medical codes on them. They are used so your doctor's practice can get paid. The prices of the procedures, test and time are made up by the practice. The prices come from a range the government formulates to keep patients from being overcharged. Those claim forms are CMS 1500(outpatient settings like clinics) and UB04 (hospitals. Used to be UB92) forms. These forms are used to make your bill come to print.

A simplistic view on the various stages on how your medical bill came to be. One wrong digit or misspelling can result in a nonpayment or complete denial. Office personnel have to make sure that the medical staff writes everything clear and precise. Which results in a long wait in the waiting room. Your bill doesn't come from thin air.