Let’s assume that you have been admitted to the hospital or are being seen in the emergency room. Not much can happen till you are seen by a physician or a nurse practitioner or a physician’s assistant. Then you can get treatment for your malady.

Likewise, all items on your medical bill come from a doctor’s order. If you are admitted it was because the doctor wrote an order to that affect. If you got an IV it is because the physician wrote the order; the same thing is true for x-ray, labs, any medications, splints, crutches or dressings.

This is simplistic and once we get into the hospital bill I will contradict myself. But for now, this is a good place to start. Once we delve deeper into hospital billing I will give examples of what Medicare will allow and what Medicare will not allow. But as I said 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.

Likewise, if an x-ray was ordered it is entered into the computer. On the computer screen it will specify if it is to be a portable x-ray or not, and what body part 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.

By the way, nursing services are included in the cost of the room or as part of the ED visit. Nursing services by and large are not billed separately. Nor can we take tips although I have been offered one more than once.

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.

But for supplies it is a different matter. I have seen supplies charged out using little stickers on the item that are transferred onto a “charge card”. Also I have seen a bar code reader that scans the item being used for the appropriate patient.

In that way the patient is billed for the item used. Now again this is simplistic and later on I will contradict myself when we discuss routine versus ancillary services. But for the most basic approach that is how the patient is billed.

It seems like a straight forward system. And it is, but as we continue our look at hospital billing errors and overcharges you will see how this becomes incredibly complex.