Monday, February 25, 2008

Medical Billing - DME Software Lookup Tables

In this installment of medical billing and DME software, we're going to cover a brief overview of lookup tables, which is probably the heart and soul of the whole DME system. Without lookup tables, the whole operation of the system, including the medical billing itself, would be extremely difficult.

A medical biller has a hard enough job as it is. When billing a medical claim, there is an enormous amount of information that has to be sent to the insurance carrier, including patient information, item information, insurance information and so on. If you read the series on DME NSF 3.01 record specifications, then you already know that hundreds of fields of information are transmitted to the insurance carrier. If the medical biller had to enter all this information by hand, the billing of one claim would literally take hours. To speed up this process, lookup tables are used.

A lookup table is essentially a self contained database that has information pertaining to that area of billing, whether it be patient, item or carrier related. The reason that many tables are used is because of the amount of information that is contained in each table. If they were all combined into one table, the lookup process itself would be slowed to a crawl because of all the records the lookup would have to go through. As it is, with very large billing agencies, these lookup procedures can take several minutes depending on how large the network is and its capabilities to handle the load.

Each lookup table is indexed, usually in several ways. By doing this, a medical biller can lookup patient information in a number of ways. For example, if the biller doesn't know the patient's ID number, they can look it up by the patient's last name. Some lookup tables allow you to do a broad search via city and state. For item lookup tables, if the biller doesn't have the sku number, they can look up the item by description. Of course, with many of the same items in the system, this method can be time consuming.

The main point of a lookup table is that for each table, there is a large amount of information that is tied to it. So by looking up a patient, the biller is pulling all the information associated with that patient, such as name, address, phone, date of birth and a number of other things. In the process, all these items are automatically pulled to the various forms that need to be filled out. So what would normally take maybe 5 to 10 minutes to fill out, can literally be done in seconds. Obviously, this is a real time saver for medical billing agencies and greatly reduces costs, which are high enough as it is.

Quite simply, without lookup tables, DME software would be pretty much worthless, as the bulk of the operation would be the manual input of hundreds of pieces of information, which would totally defeat the purpose of having the software, to speed up operations.





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