Healthcare Charge Capture

Healthcare Charge Capture

Introduction

While coding and billing patient visits consume a large amount of the physician's time, health information systems (HIS) have been historically successful in the area of charge capture, providing the benefits of speedy processing and fast cycling from charge capture to billing. Direct medical staff use of HIS is vital to incorporating clinical decision support and computer-assisted patient care management into traditional administrative functions such as charge capture and billing. (Morgan 2006)

IT helped the automation of billing and clerical tasks and trimmed significant administrative tasks and costs by accomplishing the billing process through paperless EMRs. A 2003 national survey conducted by the Harris Interactive Poll revealed that 79% of 1,837 interviewed physicians included the use of electronic billing systems, compared with 27% of them using EMRs and 24% using clinical decision support systems. This trend reflects physicians' need for and high expectation of electronic billing systems, beyond other HIS applications. A 2006 survey on eight regional health care groups in the U.S. revealed that there was increased interest in the adoption of IT to improve the quality of care; significant adoption challenges remained primarily in the area of EMRs and physician-patient communication.

Thought processes in development

Current paper slip implementation has historically needed an extended processing time for both physicians and the billing coordinator to deal with charge capture tasks related to medical staff reimbursements for patient care services. Such delays have significantly weakened the financial outcomes from hospital inpatient and outpatient practices. The observation has been that physicians were reluctant to fill out the slips because of their burden of busy clinical services. (Schoen 2007) Three major bottlenecks have been identified to delaying the charge capture work flow: (1) illegible handwritten data on the billing slips, with as much as a 75% error rate, and the need to rewrite new billing slips by either the billing coordinator or the medical staff in order to report the accurate and complete information to the billing agency; (2) incomplete progress notes on UIR's EMR that were identified by the billing coordinator did not match up to those procedures documented on the slips; and (3) the manual verification process was time-consuming and flawed. The limited space (6.5 inches by 4 inches) of the paper slip apparently is too small for the needed information (ICD-9-CM codes and CPT codes) required by individual physicians. We redesigned the work flow logic in order to eliminate the bottlenecks. Meanwhile, we investigated (1) the feasibility of a "paperless" work flow, in which physicians submit the charge capture information electronically by filling in an online data entry form available on the UIMCC Intranet Web site, and (2) practical challenges facing the electronic implementation. We hypothesized that IT can be adopted to improve the effectiveness of the billing interface, assist in record keeping, and ultimately enhance financial outcomes of the practice in the neurology and rehabilitation services. (Reich 2006)

Rationale for selecting research/project

The implementation of HIS imposes a change of traditional practice patterns for medical ...