Technology: Payback Time
Features
Written by Matt Bolch   
Saturday, 31 May 2008
Technology: Payback Time - Health Executive - RedCoat Publishing
Robust charge capture systems increase revenue with same patient volumes, but careful program selection and training are needed.
In this ever-tightening reimbursement market, every dollar counts. And when physicians and nurses have to record charges a few minutes or a few hours after seeing numerous patients, mistakes are going to be made and revenue opportunities missed.

The frenetic pace of the ED means many missed opportunities unless a robust charge capture system is adopted and used by everyone. Greenville Hospital University Medical Center in Greenville, SC installed the Picis ED PulseCheck system in its four hospitals with ED and increased revenue by $7 million in the first two years, reported Charlene Ertzberger, RN and ER system coordinator.

Revenue gains were realized by increasing billable charges while decreasing denials due to improper documentation. Ertzberger projects an additional revenue increase of $4.5 million this year, which averages to an additional $27.76 per patient.

Although this is an ED-specific product, ancillary departments can access patient records generated in the ED, alleviating the need to print and transport records between departments. “When used properly, increased patient flow within the department speeds everything up and makes records more legible and complete,” Ertzberger said.

But she cautions that charge capture software will not fix poor workflow. As the Picis system was installed, Greenville Hospital UMC studied its workflow practices and smoothed out any bumps. It’s also critical to include all possible charges to avoid backsliding to paper-based recording.

Because the practice of medicine is so highly specialized, providers of charge capture systems tend to specialize in one area, such as the ED, inpatient care, long-term care, or physician practice. A hospital should ensure that any charge capture system purchased interfaces with other hospital systems.

Best of breed
Many EMRs have rudimentary charge capture features, but they generally do not meet workflow needs for those who serve inpatients, said Dr. Steven Liu, a hospitalist at Emory Eastside Medical Center in Snellville, Ga. and the CEO of Atlanta-based Ingenious Med, Inc. Before going to medical school, Liu was an engineer, and he developed a charge capture system in the late 1990s that worked with early-generation PDAs.

Now, the Ingenious Med system has been installed in 500 facilities and is used by thousands of physicians who input data from PDAs, pocket PCs, the Internet, or a combination of electronic and paper-based reporting, Liu said.

“Hospitals should take a best-of-breed approach, adopting the revenue capture system that works best in each department,” Liu said. “You can’t have a one-stop shop for this because the workflows are so different from department to department.”

Liu said the ROI on the Ingenious Med system ranges from 1,000% to 2,000% while capturing 10% to 20% more charges. That adds up to $25,000 to $40,000 in additional revenue per FTE physician.

Point of service
The professional charge capture tool from Boston-based MedAptus, Inc. increases net collections per doctor by $20,000 to $50,000 per year at the same volume, said Dr. David Delaney, vice president of business development. Although EMRs may provide rudimentary charge capture, the imbedded function often isn’t robust enough to gain wide acceptance among physician groups.

“Paper gives you no feedback,” Delaney said. “When codes finally are entered two weeks later and put through the charge scrubbing program, the patient is gone, the chart is filed, and the doctor’s memory is shot should discrepancies occur.”

By using software that allows physicians to input charges at the point of service, the patient, doctor, and chart are together at what Delaney calls “the golden moment,” that time when billing questions can be addressed immediately to ensure completeness, correctness, and consistency of charges.

Delaney said the MedAptus system can reduce a practice’s accounts receivable by two weeks while preventing defensive downcoding that can occur when questions arise about charges weeks after the service was rendered. Through a dashboard function, charges from hundreds of providers from multiple locations can be displayed in a central location, which allows for real-time monitoring and a reduction in personnel needed to chase down paper charges.

MedAptus has a facility charge capture solution and another for infusion services. Delaney agrees that process changes must accompany any successful software installation. “Charge capture not only addresses the inefficiencies of paper capture, it also addresses overhead, resulting in a radical reworking of the way the back office operates,” Delaney said.

Training needed
Because of the more steady nature of the long-term care and home care markets, implementing a charge capture system should be a no-brainer, accurately recording the ongoing use of medicines and supplies. The fact that many of the nation’s 16,000 nursing homes have not adopted any such automated system surprises Jim Reinstatler, vice president of IT for the medical surgical division of McKesson Corp., which has its corporate headquarters in San Francisco.

“Without an automated product, facilities still use paper, which cannot provide the level of accuracy for recurring charges that automation can bring,” said Reinstatler, who notes that McKesson has been in this space for 20 years with a product specific to charge capture. The latest iteration is the Orbits PDA, which integrates with an organization’s accounts receivable package and can automate the capture of recurring charges.

Orbits can help a facility analyze cost by payors and control supply usage; gauge reimbursements figures to actual costs; and track inventory from ordering to receiving, stocking, and patient dispensing.

As with any software implementation, care must be taken throughout the process to ensure that everyone understands the changes required and has been sufficiently trained. Although the involvement of the IT department will be critical, the best leader might be someone from the finance department with a good general business knowledge or a well-respected senior nurse who understands not only the process but also the culture of the organization.

“Don’t underestimate the time and training required to implement a solution like this,” Reinstatler advised. “The payback can be substantial, but a facility must put the right person in charge to lead the effort and avoid misfires.”

Matt Bolch, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it , is a freelance writer based in Atlanta.
 
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