Wiki Submitting Charges Electronicly

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peternj

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Don't yell, I know the answer is at the end of the patient visit but my CMO wants to know what the rest of the world is doing.
When does your site mandate that your providers submit charges electronically, from the EHR to the practice management system?
We are a Federally Qualified Health Center (FQHC) multi-specialty, high volume. Right now we are using paper encounters and submitting charges electronically in order get the 'bugs' out of the system. I would be grateful for any advice or experience you can share.
 
When documentation is complete

Most of my work has been with hospital EM or EHRS being used by the Emergency Department so my experience might be a bit different than yours. But a rule of thumb is you want to allow the time for complete documentation in your EMR prior to download of charges. Or you need an edit to prevent charge download isf, or the provider can't "close" the EMR chart until complete and signed. I'm going to sound biased here, but I also think you need a review of coding done by your EMR prior to billing. I'm guessing your providers do mostly E&Ms with some visits. I haven't seen an EMR that does this coding perfectly yet.

Jim Strafford
 
You should never create the claim without first reviewing the documentation to assess the correct codes. The EMR should never be the entity assigning the codes, some EMRs SUGGEST which codes MIGHT be appropriate. Howver this should never be taken as the codes to use without a review of the completed chart note/ If the provider selects the codes, it is the same thing a complete review of the chart note is necessary to be certain the correct codes have been selected.
 
Agreed

Peter,
Looks like I stated the obvious, won't be the first time. It almost sounds like you are asking an IT implmentation question. In my experience this is at least partly an IT to IT discussion. Typically in any implmentation involving charges or demographics, a certain lead time is built in to make certain that all charges are in and registrations are complete. I'll throw out 3 days to you, but it can vary. See what others say.

Michelle,

I totally agree. But I hear a bit too often with EM/Hrs...we don't need coders anymore. When I dig further usually they do have someone reviewing the EMR or computer generated coding "reccomendations". But I'm not certain that is always the case.

jim
 
Jim I can tell you for certain it is not always the case I see different groupd os people each day as many as 90 or more in a group at times, in only a few case do the "coder" actually review the document prior to claim submission most just take the EMR suggestion or the physician entered codes. These same practices spend an inordinate amout of time fixing claims on the back end. Some of these claims do pass thru and are paid and they find out later that have mistakenly coded claims and have no idea how to correct the practice. Such as an EMR that auto assigns a dx code for carpal tunnel for EMGs, however on review the patient does not have this condition. and this has gone on for several years. The EMR is assign dx codes for payment purposes or is based on a Key word, so the provider says r/o carpal tunnel and it is ruled out but the EMR still assigns carpal tunnel as the dx for the medical necessity for the test. This kind of code assignment must stop, but only the coder can do this by refusing to assign a code until the documentation for the encounter is reviewed.
 
As a 1099 contract auditor for CMS, I can tell you that providers nationwide are regretting the EMR programs that IT agents have sold them citing that "this system will do the coding for you". It has created numerous takebacks in the tune of millions, because of unsigned medical notes and surgery reports, lack of documentation that supports level of service billed, and I can go on and on. The advice not to send claims out the door until they are verified by a coder is excellent advice. A pearl of advice, if your facility is using a program like EPIC without a coder. Another thought to process is establishing a billing system that will hit an edit before going out the door. I cannot repeat how important it is for IT implementation to receive a coder's input when establishing EMR's and claims submission programs. I see now that many healthcare IT organizations have finally learned this and are hiring experienced coders in their IT departments.
 
Secret Shoppers

Simone,

Thank you you for the interesting perspective. I couldn't agree more about both coder and clinician input to these EMRS particularly if they are coding. Frankly I think it is best if the coding feature is disabled, and the EMR is strictly used for documentation. that can be enough of a challenge!
I keep waiting for CMS/OIG to send basically "secret shopper" to ED and other healthcare sites to get services, than others audit the charts to see what was documented. I know there are ethical issues with fake patients. But to me it seems the only way to really determine if all of that comprehensive work is being done for a relatively minor problem.
Maybe this is already happening?

Jim
 
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