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Better Practice Efficiency Comes with Automation

By Managed Contracting & Reimbursement Advisor Staff  
   November 12, 2012

This article appears in the December 2012 issue of Managed Contracting & Reimbursement Advisor Staff.

Encounter forms, charge tickets, note cards... when it comes to physician documentation of professional charge information for reimbursement, putting pen to paper (maybe even a napkin) is still a heavily relied upon ­approach. Despite software advances, high physician adoption of automated processes remains elusive for many practices, and it's costing them money.

Nearly every healthcare professional implicitly ­understands that eliminating paper from the care delivery process is the right thing to do, says Ryan Secan, MD, chief medical officer of MedAptus, a consulting and technology company based in Boston. And electronic medical records are becoming increasingly commonplace, streamlining clinical work flow. The problem is that the tools aren't often optimized to support a typical practice's variety of charge coding and reconciliation needs, Secan says. So for practices contending with paper at different stops along the revenue cycle continuum, the drag on efficiency is significant, affecting physicians, the business office, and ultimately the bottom line.

"As a practicing physician that firmly believes in embracing technology for helping to make treatment decisions, improve the quality of care, and expedite transactions with payers, I see firsthand how paper bogs my peers down," Secan says. "For many of the doctors I interact with, they have access to an electronic records system permitting entry of patient charge data when they are in the office, but once they leave and head to a hospital for rounds, an entirely different work flow emerges."

For example, without a continuously updated patient census, physicians lose time looking for patients that may have moved beds or been transferred, he says. It is too common for a physician to walk into a billing office, pull a variety of papers in different states of completeness out of a coat pocket, and leave them for a coder to interpret. This almost always necessitates follow-up, protracting payment lag.

Ten years ago, paper still mostly made sense as the go-to medium for charge capture, Secan says. But 10 years ago there were no smartphones or ubiquitous ­Wi-Fi networks, and ICD-10 was a decade away. With the pace of change continuing to quicken in healthcare, paper and its associated processes are simply not equipped to keep up.

For practices looking to improve the efficiency of their administrative billing processes, charge capture technology can be a quick win. Software offerings are relatively low-cost compared to clinical systems, ­their implementation is quick, and the financial returns are ­highly measurable, Secan says. A robust system will pay for itself within a year of implementation, and with powerful complementary functionality around ­communication, reconciliation, and reporting, greater productivity will be realized across all parts of the practice.

Stop 1: The physician at the point of care

The provider benefits of charge capture automation are numerous, Secan says. Today's advanced software solutions go far beyond a simple "super bill on a screen." Coding compliance alerts delivered to a physician proactively as the charge is being created mean that charges can be billed out correctly the first time. This reduces re-work by back-office staff and ultimately lessens downstream denials.

And for clinicians using smartphone-based technology in support of hospital rounds, the patient census is always up to date provided integration with the hospital's core system. This allows instantaneous access to patient demographics, visit details, and encounter history. In contrast, many physicians using paper to support inpatient charge capture rely on outdated information printed hours or even days ago, Secan notes.

Beyond improving knowledge, a charge capture tool can-and should-expedite the charge documentation process. Easy visualization of missing charges, customizable quick-pick lists of frequently used diagnosis and procedure codes, and a current problem list all enable providers to quickly document a charge from the point of care immediately following an encounter.

"With ICD-10 looming, this type of physician-focused coding support technology will prove indispensable as groups strategize around securing provider adoption of the expanded code set," Secan says.

A last must-have function of charge capture technology is provider messaging. This is an easy way for physician users to reach coders with questions about things such as coding alerts or tricky coding situations. Again, with the advent of ICD-10, it's very important to have access to immediate coding ­support.

This type of feature, in tandem with a real-time ­compliance rules engine, delivers charge accuracy while maintaining timeliness. For providers completing charge capture within their daily patient work flow, the result is less administrative burden, more time for patients, and even dinner with the family from time to time, Secan says.

Stop 2: The central business office

"Now a practice administrator may think, 'That sounds great for helping our physicians experience enhanced efficiency, but what about me and my business office staff?' " Secan says. "That's the beauty of effective charge capture and management software. While providers are often thought of as the key system users, there are tremendous productivity benefits for the back office as well. For starters, an electronic charge work flow means greater transparency. Coders no longer have to wait for a ticket to make its way to the central business office in order to initiate the billing process."

With a reengineered approach to this process, charge data is available for review as soon as it is entered by the provider-within a matter of seconds after hitting the save button, Secan says. When it's getting toward the end of the day and ­support staff see outstanding charges, the embedded communication tool can be employed for immediate follow-up.

"No more unreturned phone calls or otherwise unnecessary chart pulls in order to get a charge completed and submitted for payment," Secan says.

What else does a state-of-the-art charge capture application provide practice leaders? Actionable data. When paper is at the core of a practice's revenue cycle, it is nearly impossible to recognize operational or compliance trends that need intervention-or elevation-as a best practice, Secan says.

With charge data available by parameters that include physician, specialty, and location, a new world of ­reporting options opens up. Insights such as provider E/M patterns, wRVU analysis, and corrected compliance errors enable greater understanding of revenue and education opportunities, which in turn facilitates continuous process improvement.

Stop 3: The bank

For a practice that is realizing greater physician ­coding efficiency, better back-office staff productivity, and access to operational data insights, there is another ­winner in the charge capture technology equation: the revenue cycle. Medical groups are able to get coding and billing done more accurately and faster than ever-­ultimately increasing revenue, Secan says.

This improvement stems from eliminating missed charges, which for many groups come in the form of consults that are never scheduled and thus expected. Then there are physicians who learn that they underbill E/M levels or habitually miss a ­procedural component that reduces reimbursement. And when groups get charges in for payment quicker, the revenue cycle shortens.

"At practices I have interacted with around charge capture technology, as much as $15,000 per provider has been experienced thanks to reduced charge lag, well in line with consensus industry estimates," Secan says.

The clock is ticking

This is a critical time for medical groups to take a step back and evaluate their overall efficiency in administrative tasks related to coding and billing, Secan says. While the ICD-10 deadline was recently pushed out one year to 2014, many experts agree the government is unlikely to delay it any longer given the resources and expense that groups have already invested in preparations.

"It seems that hardly a day goes by without a consultant or industry group recommending how to approach implementing ICD-10," he says. "Advice tends to vary by group size or specialty, but one common theme is clear: come October 1, 2014, paper isn't going to cut it any longer. Beyond 8-point font, there is no way one sheet of paper could effectively provide all of the possible diagnosis codes a physician will need for charge capture in ICD-10."

Therefore, the time is ripe to evaluate a system capable of organizing and presenting these codes for both physicians and support staff in intelligent ways that can reduce the burden of ICD-10 adoption. Groups that adopt technology to provide ICD-10 code sets for practice (alongside the ICD-9 codes used for current billing) will benefit greatly from the additional physician training and education, Secan says.

Gain efficiency, boost your bottom line

Physician practices seeking to improve ­productivity have several options to investigate. While reducing patient load or hiring more staff would mitigate administrative overhead, these approaches also hurt financially, which is simply not feasible in this reimbursement environment.

"For a group relying on paper at any point along the professional revenue cycle, or a group with an electronic records system lacking robust coding and reconciliation functionality, charge capture technology is an easy-­to-implement-and-use offering that can quickly deliver widespread productivity enhancements from the point of care to the back office," Secan says.


This article appears in the December 2012 issue of Managed Contracting & Reimbursement Advisor Staff.

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