Documentation tool can boost bottom line
Improved speed, accuracy increase reimbursement
(Editor's note: With this issue, ED Management begins a series on innovative approaches to documentation that can significantly enhance your department's revenues, without making any changes in patient flow and throughput processes. In this month's issue, we address the most effective documentation tools, proper staffing to optimize their use, and how to convince administration to make the required investment. In subsequent issues, we'll cover electronic tracking and chart monitoring, productivity incentives, and excellence in coding and billing practices.)
ED managers literally can lose millions of dollars in potential revenue by failing to use proven documentation tools and strategies to enhance reimbursement opportunities, say the experts.
"In a small, 30,000-visit ED, we improved revenue by a net $3 million of actual collections," says Robert B. Takla, MD, FACEP, vice chief, emergency services at St. John Hospital and Medical Center, Detroit. Takla declined to name the facility for confidentiality purposes.
On the other hand, he notes, not documenting properly can prove costly. "From the operational side, I've been involved in facilities where the chart handling process led to lost billing opportunities," Takla says. "Some charts were never billed for, there were delays in accounts receivable because charts weren't coded in a timely manner, and there were additional lost opportunities because charts were actually down-coded at times for lack of appropriate documentation." For example, a level IV service, if not documented properly, might be billed as a Level I, II, or III service, he says.
The difference between a Level I visit and a Level V reimbursement is about $150, says James M. Fox, MD, FACEP, vice president of Emergency Medicine Specialists, a staffing company for emergency physicians and extenders, and managing director for Midwest Emergency Services, a billing, coding, and practice management company, both based in Fraser, MI. That $150 is "money in your pocket," he says.
You have to use your documentation process to drop a charge and begin collecting, even to pursue coding and billing opportunities, Fox says. "The better job you do with documentation, the better positioned you are to go after everything you are entitled to," he says.
One of the most effective ways to do that job better, Fox and Takla agree, is to use a more robust documentation tool. Fox prefers a product named Emergency Mapping (E/MAP) from Lynx Medical Systems of Bellevue, WA. His facility started using it in July 1999. "We went from a 100% dictation process to a 100% template process in an ED that was seeing 80,000 visits a year," Fox says. In fact, he says, one of the physicians conducted a study comparing E/MAP with the T-System (Emergency Services Consultants; Irving, TX) and found that E/MAP showed significant increases in billing per patient as well as relative value units (RVUs).1
"E/MAP was developed by a company that understands coding and billing for emergency services," Fox says, "and they understood exactly what third-party payers require so the ED can get all it is entitled to."
Reference
- Frank RP, Pena ME. A retrospective convenience trial of two template-assisted patient encounter documentation systems with respect to changes in billing, relative value units, and hospital cost applied in the emergency department setting. Acad Emerg Med 2006; 13:Sup 1.
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