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Relieving the ICD-10sion: Three “must-haves” for providers looking to bolster revenue and billing efficiency

Lisa Nolan, Manager, Revenue Cycle Product Management, PatientKeeper

For all the complexity associated with ICD-10, there are some relatively simple things healthcare providers can do to prepare the front-end of their revenue cycle for the change-over. By “front-end” we mean physician charge capture, the origin of much of the practice’s revenue. The key to success is to make physician charge capture as tailored, flexible, and straightforward as possible for physicians, billers and coders.

A system is tailored when it exposes only relevant codes to physicians in a particular specialty or department, and when it provides fine-tuned code edits. It is flexible when it lets physicians enter charges on the device of their choice – a computer in the office or at home, a smartphone in the car, a tablet anywhere – and when it gives physicians the ability to use familiar clinical terminology to look up codes. And a charge capture system is straightforward when it is seamlessly integrated into physicians’ workflow via the EHR, and into the finance staff’s workflow via the billing system, necessitating fewer clicks, taps and swipes by all users.

An organization that knows this firsthand is Stony Brook University Physicians on New York’s Long Island. This academic practice affiliated with Stony Brook University School of Medicine has 17 clinical departments through which patient care services are rendered and billed. For a variety of business reasons, the group’s administrative arm, called the Clinical Practice Management Plan (CPMP), implemented PatientKeeper Charge Capture 10 years ago.  Now, with ICD-10 looming, that decision seems even more propitious.

Not that the initial ROI from their PatientKeeper deployment was insignificant.  Over a six month period, charges increased by $2.5 million ($5 million annualized) and claim volume increased by 29 percent. Overall, these departments saw a 50 percent reduction in lag days. One department with particularly dramatic results saw its number of claims increase by nearly 70 percent, while the number of coding issues actually declined by six percent. Clinicians can now quickly and easily record charges for services they deliver – at the point of care, in the office, or anywhere in between.

Along the way, Stony Brook CPMP gained valuable insight into the critical elements that make up a successful billing system.

A tailored experience

With different types and processes of workflows (and let’s face it, personal preferences), physicians need an intuitive and personalized application that easily fits into their individual work styles. A tailored user experience allows providers to build and display their patient lists in whatever way is most convenient and meaningful to them – down to lists organized by diagnosis and “favorites.”

Administrators at Stony Brook’s Department of Internal Medicine start new physicians on PatientKeeper by copying favorites from other doctors in their practice. The approach even works with hospitalists, where they build the lists by team. Physicians are instructed to use it for two weeks, then are brought back in and presented with a diagnosis list that they are invited to change. It’s tweaked to their specific needs, and then they are good to go.

Point-of-care coding

In order for providers to save time (while also improving billing accuracy), physicians need the ability to view and select the appropriate clinical codes knowing their selections will be mapped to the appropriate billing codes upon submission. In addition, it’s important for them to have point-of-care code edits, which leads to a reduction in coding errors. Having the ability to accurately specify codes in real time means fewer changes downstream for the administration staff, less time spent on research and follow-up of charges, and fewer instances of costly resubmissions and missing the claim-submission window. 

Without up-front edits, coders are often left having to input many more changes. Sometimes a procedure is performed on a patient during an office visit; the reason for the procedure may be separate from the visit, but doctors would have a difficult time remembering to add the appropriate modifier. Coders would have to go back and ask them, and an investigation would ensue. But if a code edit flags this for the physician, they know to bill for the procedure separately.

Reducing the number of clicks

Physicians still living in the paper world spend an inordinate amount of time reconciling encounter forms and index cards with multiple patient lists in order to submit charges accurately. Therefore, the need for tools that save physicians time and make them more productive and efficient is especially important when it comes to billing systems. For doctors, it’s all about reducing the number of ‘clicks’ and ensuring that all system interactions are meaningful and intuitive.

By using “macro” functionality tools, Stony Brook can capture charges simply and reduce the number of clicks physician experience. A set of charges, modifiers and diagnosis codes are grouped together and entered with a single tap or mouse click. This type of functionality eliminates confusion, saves time and ensures all services are billed.

Stony Brook is a great example that having the right charge capture solution can be transformative, leading to increased revenue and improved revenue cycle management practices.  In fact, an independent consultant that conducted a review of the practice’s lost charges found that physicians billed 99.98 percent of their patient encounters – “as close to perfection as we have seen across our entire customer base of physician and hospital organizations.”

As the healthcare industry faces into the ICD-10 transition, the time for providers to implement a more automated and streamlined charge capture methodology is now.