Advanced Revenue Cycle Analytics: An Overview
Charge Passing From EHR to PMS
The notion of EHR systems passing charge records directly to practice management systems seems logically appealing. Many of the work steps of the EHR in recording an encounter are identical to the PM work steps involved in billing the encounter. As the EHR system performs its time-of-encounter operations, it may locate and select the desired single appointment record—or at least the patient record—out of a collection of appointments (e.g., for this date and time, for this provider, for this patient at hand).
The selection must describe or be associated with its location or place of service, and its provider. It must allow the user to record the procedures and diagnoses of the encounter by using common industry code sets (i.e., CPT and ICD codes). All these things are present during the encounter cycle for an EHR system. These data are essentially the elements of a billing record—the patient, the provider, the date, the location, the procedures, and the modifiers. So to many, the intuitive next step is to connect (i.e., interface) the output of one with the input of the other. Encounter charge records out of EHR become encounter charge records into a PM system.
Problems Between EHR and PMS
Direct connection from EHR to PM can be dangerous to revenue and clinic efficiency. Providers as EHR users may or may not be adept enough, patient enough, or thorough enough to construct the billing record. Does the provider always remember to record the administration code when an injection occurs? Do they use the appropriate administration code for the Medicare patient—distinguished from the commercial insurance patient? Are they careful not to bill a component of a panel when they bill the panel as well?
In legacy workflows, the provider marked the encounter form/superbill indicating the charge elements (e.g., CPT, ICD, modifiers) then delivered the form to their staff. Various staff members would review, correct, and complete the superbill, not to correct the professional opinion or record of the doctor, but to guard against the errors that are likely among the extensive rules and requirements of the payers.
Still think it’s a good idea to let the provider be responsible for final encounter data entry? In many cases, directly connecting EHR output to PM input bypasses the opportunity for the staff to review the coding of the provider.
Solution Between EHR and PMS
Injecting White Plume Technologies’ ePASS suite into the gap between the EHR and PM systems produces cleaner, more fully and appropriately coded encounters which in turn allow practices to be fully compensated for services rendered.