Efficient reporting of charges to billing company


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I recently started working on the coding/billing for a hospitalist group. Our current procedure for reporting charges is as follows:

1. If someone remembers, one of the physicians will print off a list of all the patients in the hospital they are likley to see (It is not the complete census) and faxes that to me. I never receive this for the weekends.

2. In the following days the individual physicians will send over the same list with some sort of notation if they saw the patient (some use check marks or stars, others give me admit 3 or 2 to indicate the level of service). Every physician's is different and they do not always send.

3. I have been staying a month behind and going through the list of all patients in the hospital and coding/billing the entire hospital encounter from start to finish.

I know we are missing charges, intubations, CVL placements, OBS stays more than 8 hours but not long enough for the patient to show up on the following day's list. Can anyone think of a more efficient way to report these charges to me? The physicians are opposed to superbills. Any ideas are appreciated!


Pam Brooks

True Blue
Local Chapter Officer
NAB Member
South Berwick, ME
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Are they in private practice? maybe you could show them the financial impact of a 25% loss of revenue.....

Are they employed physicians? Then the CMO or revenue director should probably have a heads up that the hospitalists seem to require an attitude readjustment! :)

Anyway, we've had similar issues. We tried the billing cards....3x5 cards that the docs used to report their charges, diags, etc. The patient sticker helped ID them, but getting demographics to our billing company was a pain. Plus the cards got lost, two physicians would try to bill on the same day, the cards would go through the laundry...you get the idea.

Then we pulled the billing back in-house. We continued to use the cards, but had a coder track the admissions to make sure we didn't miss a day. It helped a lot, but was time consuming. Our days in AR were suffering.

Then we devised a 'charge capture folder' that prints out with the admission paperwork. This is a form that is inside the patient's paper chart (we're not fully EMR), that is in the same section as the orders (so it's handy), where the provider fills out the charge information. The HUCs can print out extras, if needed, and they apply the patient information to the form so the hospitalists only need to write down their name and a number that represents the Level of Service. We divided it into sections: Admission/Round/Discharge/Consult, and have spaces 1-31 for the days of the month. They write their name, and, for example, indicate a "3" under the round section, we know to bill 99233. After Discharge, when the chart is disassembled (about 2 days later), the charge capture folder comes into coding. Of course, coders review to make sure that the POS is appropriate, as well as to verifiy the E&M criteria. We abstract the diag from the dictation or progress note. We also run census reports to make sure we haven't lost anyone, and we still use coders to track the admission stay to identify any missed charges. I report on them monthly to identify who's not completing the charge capture folder. (It's surprising how when I share this information with them all, that they get all competitive and try to do better)

As with any paper process, it's cumbersome, so we are currently looking into a form of charge capture using a palm pilot, or other hand-held device. I know that they use this at Lahey Clinic down in Burlington MA, with great success.
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I work for a billing company and we use a program called pmdsoft it works right off their Iphone or blackberry it's easy for the Doctors and their is no paperwork I also have the ability to ask the doc a question and it's sent right to their phone and its all HIPAA compliant