Sunday, 24 March 2013

What are the Billing Entities ?

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Example 1

Dr Brown having a small Clinic Called GetWellSoon.
Patient John visiting the Dr Brown clinic for  abdominal pain .
Dr Brown diagnose the problem and gives the Treatment;

The claim will be generated from Dr Brown office

Who is the Rendering Provider ? Dr Brown
Who is the Referring Provider ? Not applicable
Which is the Facility ? GetWellSoon It is also called as Location  or Place of Service
Who is the Billing Provider ? Dr Brown
Who is the Patient ? John
Which is ICD Here ? Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or  ICD Codes or Diagnosis Codes. In this example, abdominal pain is the disease and ICD Code assigned  is R10.10
Which is CPT Here ? Treatment given by the doctor. Each treatment represent a code and that code is called CPT. It is also  called Procedure.



Example 2

Dr Brown having a small Clinic Called GetWellSoon.
Patient John visiting the Dr Brown clinic for  abdominal pain .
Dr Brown checks and ask the Meet the Specialist called Dr Joe who is having a clinic name called GoodHealthClinic

Claim will be generated from Dr Joe Office

Who is the Rendering Provider ? Dr Joe
Who is the Referring Provider ? Dr Brown
Which is the Facility ? GoodHealthClinic It is also called as Location  or Place of Service
Who is the Billing Provider ? Dr Joe
Who is the Patient ? John
Which is ICD Here ? Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or  ICD Codes or Diagnosis Codes. In this example, abdominal pain is the disease and ICD Code assigned  is R10.10
Which is CPT Here ? Treatment given by the doctor. Each treatment represent a code and that code is called CPT. It is also  called Procedure.



Example 3

Dr Brown having a small Clinic Called GetWellSoon.
Patient John visiting the Dr Brown clinic for  abdominal pain .
Dr Brown checks and ask John to take some lab test and he recommend  the Lab called Century to do some test

Claim will be generated from Century  Lab

Who is the Rendering Provider ? Lab (Because Lab does the service to the Patient)
Who is the Referring Provider ? Dr Brown. It is also called Ordered Provider (The Provider who actually order the test for this patient)
Which is the Facility ? Lab (In the Lab only, the test is conducted) . It is also called as Location  or Place of Service
Who is the Billing Provider ? Lab (Lab Need to get paid for performing test/exams on patient  )
Who is the Patient ? John
Which is ICD Here ? Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or  ICD Codes or Diagnosis Codes. In this example, abdominal pain is the disease and ICD Code assigned  is R10.10
Which is CPT Here ? Treatment given by the doctor. Each treatment represent a code and that code is called CPT. It is also  called Procedure.



Example 4

Assume that GreenPoint Healthcare is a Medical Management Companies and owns lot of small clinics and Hospital Under different name;
Assume that MyGoodHealth clinic is under them and Dr Alex is working for that clinic;

Patient John visiting MyGoodHealth clinic for  abdominal pain .
Dr Alex checks and gives the Treatment;

Claim will be generated from GreenPoint Healthcare Office or MyGoodHealth Clinic

Who is the Rendering Provider ? Dr Alex
Who is the Referring Provider ? Not Applicable
Which is the Facility ? MyGoodHealth  . It is also called as Location  or Place of Service
Who is the Billing Provider ? GreenPoint Healthcare
Who is the Patient ? John
Which is ICD Here ? Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or  ICD Codes or Diagnosis Codes. In this example, abdominal pain is the disease and ICD Code assigned  is R10.10
Which is CPT Here ? Treatment given by the doctor. Each treatment represent a code and that code is called CPT. It is also  called Procedure.

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