Capturing all charges

One surefire way to guarantee that you won't be paid? Don't send the bill.

Key Points

As you're leaving Costco or Sam's Club, an employee at the door checks your receipt against the items in your cart. She's looking for items that aren't listed on the receipt. It could be something accidentally overlooked at checkout. Or you and a dishonest cashier could be ripping off the company. Either way, the store goes to a lot of trouble to prevent missed items. Do you have somebody like this in your practice?

One surefire way to guarantee that you won't be paid? Don't send the bill. And yet all too often, services that doctors work hard to perform are not being billed at all.


With the first cool weather of fall, the doctor took his herringbone tweed jacket from the back of the closet. It was like meeting an old friend after the long, hot summer. He had last worn the jacket in March. Rummaging through the pockets, he came across a scrap of paper covered in his familiar scrawl. With a sinking feeling, he realized that it was a complete summary of charge information for a patient he had admitted through the emergency room 8 months prior. The office, unaware of the patient, had billed none of the services.

Every physician needs some sort of mechanism for collecting and reporting charge information that occurs outside the office. A diary, notebook, or weekly hospital list are options frequently used. The mechanism you use is less important than the reliability of your using it. Our preference is a list of patients for a specific period of time-a day or a week-rather than individual pieces of paper for each patient. That's because it's easier to notice a missing list than it is to notice a single missing item on a list.


Someone in the office needs to debrief each physician on a regular and formal basis. We've seen systems wherein the physicians deliver the hospital list to the billing clerk daily, receiving the new hospital list at the same time.

Some physicians keep a weekly diary of billable activity, turning it in periodically so the biller can download the information into the billing system. In other practices, the doctors enter the charges on a wall-mounted blackboard listing of patients in the hospital as they come in the back door.

The authoritative billing record for surgeries usually is the surgery schedule. All surgeries should be recorded on the schedule and, when billed, a notation of the date the charge was posted to the computer made in a distinctive ink color (or font), along with the codes billed and the fees. Then it becomes a simple matter to periodically scan the schedule, looking for surgeries that have not yet been posted.

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