Active Forum Topics | Getting Started | Interviews | EMR Forum | Medical | Billings | Press & News | Voice Recognition | The Water Cooler
Over the past four years I've done probably 15 or so data conversions from one billing software to another. I have also interfaced between different EMR's and our billing software. Over the course of all this work, naturally I get to see the data involved since I have to spend a great deal of time cleaning the data as much as possible. Some of the things I see include but are not limited to:
1. Missing birthdates.
2. Missing/incorrect gender specification
3. Incorrect last names
4. Incorrect/missing diag codes
5. Missing/incorrect modifiers
6. Incomplete policy information
I could go on here but you get the point. In every interface I have done with an EMR, we have had to go to the doctor's office and train them on how to properly enter modifiers/diags/etc because the doctors were putting that information in wrong or not at all.
No insurance company is going to pay you if your data is crap.
And yet that seems to be what many doctors expect.
Give me your database and one hour with MS Access and I'm virtually certain I'll find THOUSANDS of records with some or all of the issues I listed above.
In the age long battle between carriers, providers, patients, and government perhaps it is time to start looking at things like data quality and less at who can get the most politically out of whom.
JamesNT
Regards, JamesNT
That is a very good point. Many times, the physicians support staff are to blame for these data entry failures.. EMRs can help this situation by making data fields such as gender and insurance information *required fields.
lroman@webdmemr.com
www.webdmemr.com
Hearing similar complaints from docs regarding their staff, we allow physicians to choose those demographic fields in Medtuity which must be filled in. For example, first name, last name, birthdate, address1, city, state, zip etc can be picked once as absolute fill-ins. Thereafter, if a staff enters inadequate info, Medtuity warns which field(s) are incomplete.
But that also gets in the way of putting in a "placeholder". For example, we have scheduling built into Medtuity. If a never-seen patient (a referral, for example) calls for an appt, it is customary to put a placeholder in with the intention of filling in the remainder of the info when the patient arrives for the appt. Of course, the placeholder info may not be complete enough (let's say firstname, lastname, DOB only) to fulfill the criteria laid down by the physician.
While a placeholder is convenient and meant only as a stop-gap measure, it can be a source of error later if not completed.
There are ways to allow both. For example, the automatic check is not done UNLESS the pt is going to have an encounter documented. That allows a placeholder when the pt calls, but an automatic check later when the pt is put on the tracking board in anticipation of documenting an encounter.
We also have an option that does an automatic check at the end of documentation for an ICD9 and CPT level. I'm not sure how many of our users have that toggled on-- probably a minority as they are intrusive.
Making fields required is one answer but probably the bottom one on the ladder. The more feilds you make required, the more people are just going to put in place-holders.
Getting correct data to the carriers is a matter of two things:
1. The doctor MUST fill out the correct information on the Superbill.
2. The staff must be educated on what is required. I seem to recall seeing someone on this forum complain about the costs of hiring computer literate staff, well, welcome to the 21st century. Gone are the days of hiring the busty 21 year olds that know nothing (something I still see a lot of doctors still doing). Offices actually do need someone who understands billing and coding and has good work ethic. If you plan on outsourcing your billing to a billing center, be sure to have it stated that you can cancel your service at any time AND that they will send your data back within 15 days or less.
James, the way i look at it is that the insurance company owes the money. Therefore, if they see something is not quite exactly right, why don't they make an effort to fix it. Hmm, Joseph Smith, but the gender is not filled in...we won't pay. To me, this is criminal and they are defaulting on a bill.
These days the emr/billing software should handle all of this.
Graham http://www.synapse-ehr.com/ Synapse - the EMR for the superior physician
gchiu: These days the emr/billing software should handle all of this.
It does. Most software will not submit claims with missing or bad data, and if you electronically check eligibility at the front end, there should be no demographics errors in the actual claim. As to the coding, there is some help in the software, but ultimately you will need someone that knows what they are doing in the office.
Margalit Gur-Arie
My brand new Blog: On Healthcare Technology
What is the usual interval for billing?
Is there an advantage to billing weekly compared to monthly?
I'm referring to payers that do not accept electronic billing. My best payer does not accept electronic. I bill once a month. Is this foolish and if so why?
Chris Wilkerson, D.C. Carson Doctors Group TabletPCs in Medicine Editor-in-Chief www.MedicalTabletPC.com Home: www.Digital-Doc.com
Doctors are mostly untrained and uncomfortable with coding properly. The notes you see now and being developed are designed for the purpose of coding that there is no relevance to the care of the patient.
Only 27% of Physicians belong to AMA, yet it continues to thrive garnering hundreds of millions selling these codes you refer here that they update and sell yearly. So for all they care AMA can only have 1% or even less members and will still continue to thrive.
With the CMS budget cut, the product you sell should be able to sort out automatically without the Physicians hiring "professional" coders to get to their pay roll in addition to other staff,( just like the time of my father where one Physician only requires one staff - 1:1 ratio), what to charge properly. If we applied these process with the food industry I am sure the restaurant business will fail and go bankrupt faster.
As to billing, we bill patients as soon as they leave the door. By the time they reach their car, it is already sent. What you say here is very very true. I have seen extremely busy practices that went under due to their inabilities to handle these. So now close to 85% in my area are employed in a corporate set up, who likewise have issues in the complex web of billing.
Roger,
How can you bill the patient so quickly? Don't you have to bill the insurance first and only after they pay their share, bill the patient?
Lots of vendors will tell you that the software bills automatically. What that means is that once you select the diagnosis code and the procedure code, the claim gets created automatically and in some cases goes out automatically. However, someone has to select the codes (ICD and CPT) to start with, and they have to be correct and correctly paired and have proper modifiers if necessary. The entire system is way too complex and about to get even more complex with the ICD10. Unless they change the system, either the physician knows how to code real well, or he/she needs a coder in the office, no matter how automated the software is. Some billing services will code for you from dictation only, in which case you leave it all to them and hope you get paid as much as you should.
Chris,
That must be a really small payer, if they don't accept electronic claims. The math is very simple. The sooner you get the claims to them, the sooner you get paid. The ideal situation is to bill every day. Waiting a month is equivalent to extending them credit for a month.
elidan:How can you bill the patient so quickly? Don't you have to bill the insurance first and only after they pay their share, bill the patient?
1. We complete 90% of our note during the encounter. The remaining 5 to 10%, we just complete the diagnosis, pending cleaning or completing the note.
2. The main weapon we have in the practice is my wife, a board certified Pediatrician, who voluntarily elected to run the practice. She wears alot of hats, administrating, coding, policies, human resource and also now teaching billers. I wonder how we can start our own school as literally those tech school graduate students that likely have no clue.
3. We have chronic diagnosis encoded on the emr. I just need to push these more to the potential of the emr to use the praxcoder, but for convenience sake and since literally our administrator (wife) and the manager are wizards on coding, we opted not to. But I think it may make us much mjuch faster and productive if we link all diagnosis.
4. Coding and billing have to be done as much as possible the same day. Its all about cash flow. Billing beyond 3 to 5 working days is not a good sign.
Keep your collectibles as low as possible.
I suppose one has to have an ultimate obsessive compulsive staff to thrive nowadays
Does she still see kids?
gchiu: Does she still see kids?
She calls herself officially retired. But it looks like practicing would give her more time. But at least her time is flexible. We are determined to be free from corporate medicine, but the current climate seems to discourage it. We still hope.
sweaner: James, the way i look at it is that the insurance company owes the money. Therefore, if they see something is not quite exactly right, why don't they make an effort to fix it. Hmm, Joseph Smith, but the gender is not filled in...we won't pay. To me, this is criminal and they are defaulting on a bill.
This is exactly the attitude I'm talking about. Consider that if you send in a claim with a missing information, how is the insurance supposed to fix it? Either your information is wrong, or the information supplied by the patient when they first signed up is wrong, or someone is trying to defraud the carrier. For example, the carrier cannot say, "well, the patient's name is Jamie Summerlin so it MUST BE MALE!" I know plenty of Jamies that are female. Couple that with the fact that there are many procedures that are FEMALE only (e.g. pap smear) and you have a real situation on your hands.
Furthermore, the carriers have every right to know exactly what they are paying for. If you send in incorrect information, are you trying to defraud them? No one at the carrier's office knows who you are, or who the patient is, they just have what's on file.
Lastly, the carriers used automated processes to send claims through and either pay them or deny them. Sure, they have help staff for phone calls, but those staff are their for the exceptions, not the rule. It is cost prohibitive for the carriers to manually process all claims and have investigators hunt down bad information just to get it fixed. Besides, how would you feel knowing your front desk clerk just took 15 phone calls from 8 different carriers asking to verify birthdates and so forth and the only thing she could tell them was "I don't know" since you didn't have that information to begin with? Why, yes, the carrier could just call the patient and then you get to deal with the patient screaming at you because they had to help the carrier CLEAN UP YOUR MESS because the stupid little 21 year old with big boobs you hired typed in 11/21/1988 instead of 11/21/1978 for a birthdate or because you are to incompetent/lazy to circle RT for the modifier to show the procedure you performed was on the Right Foot.
Sorry, but your argument doesn't cut it.
There are days when I wonder if you single-handedly developed synapse on your own or outsourced it all to India.
The billing software can make the field required, but ultimately it is trash-in/trash-out. If a user accidentally clicks M for Male when the patient really is a female, there isn't much the software can do. If the user types in 06/12/1988 for the birhdate when it should have been 05/12/1988 there isn't much the software can do. The same is true for CPT'S and modifiers. You can set up some rules that certain CPT's require certain modifiers to be chosen, such as in podiatry the user should choose RT or LT, but you then run across the situtation of the users entering "place holders" with the idea of fixing it later but later never arrives.
If your software is so bad-ass enough that it magically knows all these things or at least how to handle them , then please show us some examples to lend your argument credibility.