Show me the money – All in one place

Amy Sullivan, Vice President - Revenue Cycle, PatientKeeper, Inc. - Print  | 

I manage my personal finances from an app that aggregates all my bank accounts, credit cards, long-term debt, spending and investment data from at least a dozen sources and presents it to me in a unified view.

Automated alerts flag everything from basic spending aberrations to the likeliness of meeting retirement goals. It’s easy, intuitive, and a huge time-saver. I know that I am managing my personal finances more effectively and saving more because of it.

One app for managing all that data – wow, what a concept!

Wait a minute. Could something like this be useful for healthcare billing?

In a word, yes – though the challenge is far greater because healthcare billing is more complex. A single, unified view of data would be especially helpful to practice administrators and billers trying to identify all the potential professional charges that could or should get billed. After all, when physicians provide patient care, that is where the healthcare revenue cycle begins. If charges are not captured, then revenue is not generated.

Stand-alone charge capture systems have one main challenge: how to ensure that all reimbursable professional services have been captured. In the outpatient world, this is relatively simple – an arrived visit equates to a charge. In the inpatient world, however, physicians are pulled in many directions – they round on their own patients, they do consults, they cover for other physicians on their team, perform surgeries and more.

Therefore, what would be extremely useful is a charge capture system that includes a professional billing aggregator that combines documented notes and billing patterns to alert physicians and coders when charges should (or should not) be expected. Notes are the source of all truth – for patient care, for care team review, and for professional charges. If there was a note, then almost certainly there should be a charge.

For example, a billing aggregator with a smart rules engine could alert a coder that a preoperative history and physical should be billed because the surgery was cancelled. Such a tool also would be extremely useful now that the Centers for Medicare and Medicaid Services (CMS) is going after providers seeking reimbursement of unsupported Meaningful Use (MU) incentive payments. Organizations would not be left scrambling to find the documentation that supports past charges if a billing aggregator alerted physicians that documentation was missing on a particular date of service, or that a procedure code was found without supporting documentation.

An automated charge-note reconciliation tool, properly implemented, should be able to find the 10-15 percent of professional charges that many healthcare providers unknowingly fail to submit. And, if used in a timely manner, this tool could prevent charges from being written off due to the payer’s filing limits, and even perhaps help avoid a CMS revenue audit.

You might think that electronic health records (EHR) systems would provide a unified data view and charge capture workflow of the sort I have just described. But you’d probably be disappointed. In fact, at many provider organizations the incumbent EHR system represents more of a distraction than an enabler to effective revenue cycle management, especially as healthcare moves toward value-based reimbursement.

A recent survey found that nearly two-thirds of all physicians feel unprepared to manage and execute the Medicare Access and CHIP Reauthorization Act (MACRA), the federal government’s programmatic approach to pushing value-based reimbursement. This is understandable, given that so many physicians continue to wrestle with poor usability and related workflow implications of EHRs, and hospital IT organizations continue to place “EHR optimization” above MACRA implementation on their priority lists.

There are multiple factors contributing to the EHR distraction. For example, Health & Human Services Secretary Tom Price has stated that mandated EHR adoption under the 2009 HITECH Act has negatively affected provider workflows and has impeded patient care. That said, the well-known imperfections of today’s EHRs are no reason for provider organizations not to utilize available technology to improve revenue cycle management generally – and complete, accurate professional charge capture specifically. Reputable third-party vendors of enterprise-class tools know how to integrate their software into EHRs to provide a smooth workflow for clinicians, billers and coders. So even a less-than-optimal EHR can be made useful for the purposes we are discussing here.

While new value-based payment models certainly hold immense promise for healthcare from both a cost control and quality improvement perspective, having a firm grasp on capturing physician charges will remain a key to financial health for provider organizations for years to come. Toward that end, the healthcare equivalent of the personal finance app I find so useful would surely do wonders for billing professionals at hospitals and medical practices.

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By Amy Sullivan, Vice President - Revenue Cycle, PatientKeeper, Inc.

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