Electronic encounter forms are the critical link between practice management and the electronic health records system
One of the key benefits of an integrated system is the electronic encounter form (EEF), a powerful tool that can significantly impact your practice. The EEF automates sharing of clinical and billing information between the EHR and PM applications. The EHR can automatically insert billing codes and diagnoses into any progress note. The ICD-9 and CPT codes are automatically transferred to the billing system. The billing clerk or office staff can quickly review the charges and diagnosis codes. If everything is OK, she need do nothing; the charge is already posted for automatic billing.
The physician can also initiate actions from the progress note. When needed, he can communicate the need to schedule labs, X-rays or a specialist referral so they can be managed as part of check-out.
Finally, the EEF can be customized to ensure the most commonly used diagnoses, billing codes, modifiers and action codes are readily available, streamlining the process.
Your Experience Using the EHR
In the beginning, most physicians use VersaForm mainly as an electronic version of the patient chart, providing a convenient way to store data without duplicating information between databases. The templates provided by the system were convenient for progress notes, but linking the clinical and billing information is something that needs to be customized for the way each practice works. You'll be pleased when you see the role the EEF could play in streamlining productivity and improving billing.
You'll need to talk with your staff about information that would be most beneficial. Then spend a few hours creating progress note templates that include text notes, common codes and various modifiers required by insurance companies. It's a good idea to start with just a few menus. That way, you can test how they work out with your staff, and get their feedback. It does not take long for the staff to get completely comfortable with the new and improved workflow.
For the majority of visits, the process is very straightforward. If you are seeing a diabetic patient for a checkup, you'd open the appropriate note template. Along with the clinical data, that template would include a menu (Figure 1) to enter the diagnosis, if you have not done so already.
Figure 1: Diagnosis Choices in Diabetes Template
If the proper diagnosis is not in the menu, there is an easily accessible list of 50 or more diagnoses (your "Frequent Diagnosis List") that can be inserted with a few clicks. If the diagnosis is rare, you can still search the full ICD-9 listings or just leave a note for the billing staff to look it up.
A second menu (Figure 2) enters the billing information.
Figure 2. A CPT Code Menu
When you finish the note, that information is already in the billing system (Figure 3).
Figure 3: Ledger with Line Just Added from Progress Note
You will immediately realize increased productivity due to the elimination of duplicated efforts. In the past, you would circle codes on the paper superbill and pass it along to the front office staff. They would call up the account in the billing system and enter the code by hand before sending it off to the payer. Now, I enter the codes on the EEFand my staff needs only to verify, rather than re-enter, the information, and the charge posting is automatic.
This markedly reduced the risk of typographical errors. In the past, if the billing staff entered a 99393 (well child check 5-11) instead of a 99392 (well child check 1-4), we wouldn't catch it until the denial came back. Now the information is fixed in the template, reducing possible mistakes.
Another benefit is a dramatic reduction in missed charges and denied claims. Before, if something wasn't circled on the superbill, it wasn't billed. Now, because of VersaForm's templates, proper documentation is automatic. An example of this is the vision screen at well child checks. If you forget to circle the vision screen code on the superbill, it does not get billed. Now the item for that code is automatically included, and you only have to click on it to bill, resulting in an improved capture rate.
By including billing items in your progress note templates for rapid strep tests, urine tests and appropriate shots, for example, your nurses are able to easily and accurately document encounters and capture charges with just a click or two.
Another important benefit relates to administering vaccines. In some states there are more than a dozen different ways to bill vaccines, and several insurers have their own set of complex rules. In the past, you may have gotten denials because, when entering the paper claim into the computer, the biller would forget to check the child's age or if it was Medicaid or private insurance. Now, with the integrated system, the nurse simply documents the vaccine and the template includes items for the patient age, insurance and whether it's the first or second vaccine administration. The progress note selects the appropriate codes and modifiers and the system creates a clean claim.
Most of your claims can be handled this way. The only exceptions are the very rare codes that are not on the "easy diagnosis list", and codes like skin lesion removal that require a pathology diagnosis. In this case the note is finished on the day of the visit, but the billing is hand coded when the pathology report comes back.
Implementing the EEF can have a significant impact on your bottom line. In exchange for a few hours of setup time, you will be able to improve productivity, reduce denied claims, and save on additional staff and outsourced services.
In some cases, the saving has been an alternative to outsourcing, or hiring additional staff. Outsourcing can cost 7 percent of your revenues; hiring a part time person could cost $20,000.
As for denied claims, the reduction in errors is tremendous. If your payers are especially picky, the use of a template gives you a way to remember the special requirements. It's not impossible to make a mistake, but with the reminders hard-coded into the template, it's much harder.
The tools available through an integrated system not only improve productivity, but also speed the revenue cycle and enhance revenues themselves by capturing previously missed charges and reducing or eliminating denied claims. The return is well worth the initial investment for a practice of any size.