So here is day 2 of being a blogger. I'll just get into it and tell you what I do.
I work at a hospital, where Doctors see patients. Those Doctors then want payment. So they submit their work to the insurance companies (if the patient is insured) and the insurance pays them (hopefully). Anything the insurance does not pay, the patient is responsible for. My job is to submit that work to the insurance company so the Doctors can spend their time actually seeing the patients instead of just tromping through red tape.
It's actually more complicated than that and we have a multi-step process with different departments and positions.
Step 1: Collect Underpants...
Er...
Step 1: Doctor see's patient
Step 2: Doctor writes down what happened - dictation
Step 3: Dictation goes to insurance
Step 4: Insurance checks coverage dates/amounts
Step 5a: Insurance pays
Step 5b: Insurance denies payment
Step 6a: Money is recieved and there is much rejoicing
Step 6b: Appeals begin
Of course this is not as simple as I make it look. I don't actually send the dictation to the insurance. I 'translate' it first. It's more like encoding a message for delivery in a covert operation. You see, the insurance company doesn't want to determine how much money should be paid for putting 5 stitches in a scraped knee, vs. 8 stitches. That's where my job comes in. The government has largely regulated how much money can be gotten for stitching up a knee. It's because Medicare is the largest insurance payer in the US and that's all government. The way they regulate it all is by having each problem get a numbered code, and each treatment get a numbered code. I have to find the correct codes and give them to the insurance.
So there's these books...
There's one for "Why you saw the Doctor" and one for "What the doctor did". Each of them is about the size of a phone book, with thousands of codes in each. So each time you see a doctor, someone like me is digging through a 'phone book' size code book for what's wrong with you, and then another 'phone book' size code book for what the doctor did.
Of course, the Doctors don't always write everything down, sometimes I can't read thier handwriting, there are spelling errors, and sometimes they just forget something. I still have to figure out what they meant.
Of course, on top of all that, I work at a teaching hospital.
Yes, like that show, ER. Doctors come here to teach other doctors, and the ones that are being taught are seeing patients. This adds more complications to billing out visits for the Doctors. When a student takes all of the medical classes to become a doctor, they have to spend a certain amount of time at a hospital doing rounds with an Attending doctor, learning what it's like to work at one. They don't get paid for this, so I can't bill anything they do. After they graduate, they still don't know that much about being a doctor, so they have to take up a residency under a teaching Attending Doctor somewhere. They still don't get paid for this, so I can't bill anything they do. But Medical Students and Residents document what was done to treat the patient. So the Attendings are the only one's that get paid. And that's where most of my complications come in. Now that I've properly set up what this blog is about, I can get into. - with my next post. Need to go read some charts.