Charge Review Process

[pjcurley]

When evaluating an EHR, What do you look for in a basic Charge Review Process? Sorry if too broad a question, but I'd think patient, Date of Service, Payer, provider, Dx, Service Item, Modifier. What else, if anything?

Thanks!

 

[csperoni]

I would want it customizable as different payors may ask for different things. Example for today's world - telehealth. Most want modifier -95 and POS 11 (or whatever it would have been if not for the pandemic). Others have different requirements. Example for my specific field of gynecologic oncology. Prior to 2019, my physicians were performing a specific procedure for lymph node mapping that was best described by 38900 but that is an add on code which only had breast procedure base codes until 1/1/19. Some insurances would accept 38900 regardless. Some insurances wanted 38999 unlisted. I was able to build that rule into the billing portion of my EHR in case I didn't realize when coding which insurance the patient had.

I personally don't expect my EHR to know all the rules for specific procedures and carriers. I expect to be able to build my EHR to what I want it to be.
That being said, there are many practices (specifically smaller private practices) that may not have a CPC working there, or the office manager is not even familiar with billing rules and coding edits. To further complicate, coding edits change all the time (CCI is updated quarterly). CPT and ICD10 are updated annually and when there are significant changes (COVID19) sometimes even change in the middle of the year.

I won't say they don't exist, but I've never seen an EHR that had accurate rules built into it.