kudzuOne of the most famous examples of the law of unintended consequences is Kudzu. Introduced to the United States in 1876, the plant was originally intended as erosion control. Currently spreading at a rate of 150,000 acres per year, the plant will overtake everything in its path when left unchecked.

What are the unintended consequences created by your EMR implementation? EMR systems were intended to function as a clinical application that would replace the traditional paper chart with an electronic record that was more readily accessible, searchable, and shareable. As users began to input data into the EMR, administrators noticed all of the information necessary for billing could be captured from the EMR. When physicians use EMR templates to build charge information in their EMR, charge data can be passed directly to the PM system for billing. This could save a practice time on charge entry and eliminate the paper superbill! This is where the problem began.

A step forward clinically should not be a step backwards from a billing perspective.

Think back to those charge entry employees. Usually, when keying charges into the PM system, the process is more complicated than simple data entry. Those employees are required to actually fill gaps in the claim that were missed by the physician or are required by every insurance carriers. When the charge entry process is automated by EMR, charge data flows directly from the physician into the PM system without the benefits of a claim review.

Are you brave enough to have charge data go directly from physicians onto a claim?  Most physicians do not want to be medical coders or have to remember thousands of coding rules that apply in different scenarios with different payers. Most billing and A/R staffs would rather not receive denials resulting from charges going directly from physicians onto a claim. The solution most billing managers employ is to designate the same charge entry employees used before EMR templating to review the charges from the EMR and make corrections prior to submitting the claims. This erodes the savings from automating the charge entry process!

There has to be a better way than having someone manually review each charge after templating in an EMR.

Many medical coding solutions and claim scrubbers promise a better way. When looking for a solution, realize the ideal solution should not be an afterthought or one feature on a list of a hundred features. Medical coding is extremely complicated and is critical to the revenue of the practice. A coding solution should be carefully examined to determine:

  • What types of rules does it include
  • When are these rules applied
  • Who reviews these errors and makes the corrections
  • How are the errors presented and corrections made

Be careful not to let the kudzu overtake your carefully manicured billing process. Overgrown already? Seek a medical coding and claim scrubbing solution today.