Medical Billing - Doctor Files Overview

Medical Billing - Doctor Files Overview

We all live in our own little world. What we see in front of us is pretty much all we believe there is. In the world of medical billing, this can be a nightmare waiting to happen when it comes to doctor files. Why? Well, there are quite a few reasons. We're going to cover some basic things you will need to know about your doctor files before setting them up in your DME billing system and then afterwards when you're getting ready to bill them.

The first thing you need to be aware of is that if you are a medical billing agency, you will most likely be billing all kinds of claims. They can range from people with broken legs who need wheelchairs to people who have smoked for 50 years and now need oxygen because of it. Both bills require not only different pieces of information to be sent but different kinds of doctors. Most likely, the patient with the broken leg has gone to an orthopedic surgeon. The patient with the bad lungs probably went to a heart or lung specialist. Why does this matter when it comes to billing for services rendered?

For starters, these doctors have different kind of billing practices. They also belong to different medical agencies, even though they both fall under the general blanket of the AMA. Why does this matter? Because the way each doctor's insurance is set up with the various agencies such as Medicare and Medicaid is different. Each is governed by different rules and regulations. Oxygen, as an example, is highly regulated. Much more so than simply setting a broken leg. You're going to have to jump through more hoops billing the doctor for the oxygen claim than for the doctor who set the broken leg. Again, how does this affect the setup of the doctor file itself?

Each doctor file has a number of fields. One of the most important of these fields is the category that the doctor falls into. This category must be transmitted to the insurance carrier, either on the paper claim or in the electronic billing format in the doctor record. Because of this, you want to make sure that when you setup your doctor file for each doctor that you include the correct category. What happens if you don't? Simple. The claim will be denied and for reasons that you can't even comprehend, not the least of which is that the doctor isn't authorized to perform the procedure. It might seem like a simple and stupid thing, but it's the simple things that usually trip up most claims.

When you're actually billing the claim, after the doctor files have been set up, you want to make sure that you're pulling the right doctor for the patient. The way this is usually done is by a cross reference in the patient file to the doctor file itself. This way a screw up isn't possible, unless the initial cross referencing is done incorrectly to begin. That's why you need data entry specialists who have to be extremely careful.

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