Once you arrive at the emergency room not much happens right away. Only after you are seen by a physician, nurse practitioner or physician’s assistant can treatment start for your malady. That is also the time when charges start to accrue.

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.

Now before we get too far along let me say this is a simplistic view. And if you pay attention you will see how i contradict myself. And to add Medicare into the mix is another dimension. But we will talk about that 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.

I know from my own personal experience that before the order for a lab draw or an x-ray is performed the techs want to know if that order is in the computer. And that is how it should be, after all the techs want to be paid for their effort. And once the order is in the computer it allows the patient to be billed for that service.

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.

So any service provided by the hospital for your care should be entered into the computer. It doesn’t matter if that service is an x-ray or to order a meal or physical therapy or even a breathing treatment, it will be in the computer. Even a consult for another physician for a surgeon or a gastroenterologist is entered 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.

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.