Software to help your billing—and your bottom line
Charge capture programs can speed up reimbursement and improve accuracy, but are they for you?
Copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.
By Bryan Walpert
Applications to improve billing and coding
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Alessandro Bellucci, MD, is the first to admit he used to hold on to his scribbled index cards for as long as a month.
Like many physicians, the nephrologist at North Shore University Hospital in Long Island used the cards to capture inpatient charges. Though his billing office encouraged him to turn them in every week, he often hung on to them to avoid having to rewrite information for patients who stayed longer in the hospital. There were even times when he didn't write down a charge because he didn't have the patient's card on him.
Now, however, he enters all CPT codes directly into his handheld computer using ChargeKeeper software from PatientKeeper. Several times a day, he links—or "hot syncs"—his handheld to a personal computer in his office or at a nurse's station. With that, he sends his charges to billing electronically.
"At this point, I couldn't do without it," Dr. Bellucci said. "It's a part of my routine."
Despite such glowing testimonials, coding and charge capture software for handheld computers is just beginning to catch on. According to a report from Fulcrum Analytics and Deloitte Research, only about 6% of physician PDA users used charge capture software in 2001. Some vendors have only a handful of clients, and they are often large clinics or hospitals rolling out the application in pilot tests to a small number of physicians.
But experts say that charge capture may deliver the technology's biggest benefit for physicians because it has the potential to save-and make-them money. The software is designed to curtail lost charges, improve coding accuracy and reduce the time it takes to send charges to insurers. That can dramatically reduce delays in reimbursement.
"Billing is the 'killer application,' " said Holly Whitaker, director of consulting and practice lead for health care at the Watertown, Mass.-based Arcstream Solutions, which helps hospitals choose and implement technology. "Charge capture software can directly affect your bottom line."
Faster billing
Most physicians now rely on billing systems that are often haphazard at best. Charges on both office encounter forms and three-by-five hospital cards have to be entered by hand. Note cards and encounter forms can also get misplaced, meaning that charges don't get billed and you don't get paid.
Consultant Elizabeth Woodcock once worked with a group of pulmonologists in Kentucky. She recalled watching the person responsible for posting charges walk to the coat closet in the morning and go through pocket after pocket, pulling out crumpled bits of paper. She eventually found $10,000 in charges.
"I've seen groups not bill for as much as 25% of their consults, which is a lot of money to leave on the table," said Ms. Woodcock, an Atlanta-based independent consultant with MGMA Health Care Consulting Group and director of knowledge management for Physicians Practice Inc., a Baltimore-based publisher. "Charge capture has been wonderful from the perspective of return on investment."
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Charge capture software can benefit physicians by helping them save—and make—money. |
Charge capture software is designed to eliminate billing delays and streamline the billing process. Studies of several customers using ChargeKeeper showed an average five- to seven-fold return on investment, according to Stephen S. Hau, a founder of PatientKeeper in Brighton, Mass. Every dollar spent on the system returned $5 to $7 in billed charges.
Lahey Clinic in Burlington, Mass., which has about 450 physicians, conducted its own three-month test of the Boston-based MedAptus Charges in Hand system earlier this year. It examined charges from 16 physicians in general internal medicine, gastroenterology, general surgery and neurosurgery.
The result? The length of time it took charges to get from point of service to the billing system fell from the clinic's average of three to five days to only half a day. Lahey is now rolling out the PDA charge capture system gradually to all its physicians, planning on full implementation by the end of 2003.
Accurate coding
Charge capture software is also designed to make sure that the right codes go to the insurance company. MedAptus found 17% more errors—the wrong CPT code being entered, for example—when physicians used a paper process instead of PDA-based software, said founder and chief medical officer Lance Baldo, MD.
Typically, you won't have to choose from 10,000 different codes every time you see a patent. Instead, vendors create lists of frequently used codes by specialty or by working with the physician. When a small group of Lahey Clinic physicians started using the MedAptus software last year, for example, coders worked with physicians to customize the coding templates MedAptus provided.
Software can provide other help. If a particular code doesn't make sense, for example, some software will produce a pop-up screen, reminding you that it is inappropriate to charge for an initial consult if the patient has been seen in the hospital twice that week. And many systems come with a built-in evaluation and management (E/M) calculator.
Physicians who use PDAs, however, disagree about the usefulness of that feature. George T. Griffing, FACP, a general internist and endocrinologist in the department of internal medicine at St. Louis University, for example, has the option of using an E/M calculator through EveryCharge from the Durham, N.C.-based MDeverywhere. Though he uses the calculator as a teaching tool-he likes to show residents the work required for various service levels, for example-he does not use it for his own patient visits.
Dr. Griffing already has to check off or fill in the appropriate physical, history and decision-making information on a paper form for his chart, and a table at the bottom of the form helps him determine the appropriate visit level. For him, it's not worth taking two or three minutes to double-check the calculation on his PDA. "It would take too long to go through the E/M calculator," he said.
J. Fred Ralston Jr., FACP, Governor for the Tennessee Chapter, uses the stand-alone Stat E&M Coder from StatCoder.com, for a similar purpose. While using the E/M calculator for every patient visit would be cumbersome, he said the software "has made me very confident about distinguishing between level 3 and level 4 office visits. The program's status bar clearly shows the elements needed for various levels of care in a way that manuals never effectively do."
Jeffrey E. Lyon, ACP-ASIM Member, an internist who works exclusively in the hospital for St. Mary's/Duluth Clinic in Duluth, Minn., also uses the Stat E&M Coder. He said the software allows him to document work he's done but might forget to write down.
If he has sent a patient with unstable angina to the cardiac catheterization laboratory, for example, the software reminds him to provide any context that may justify the procedure, such as a note that the patient was bothered by the angina two weeks earlier while climbing stairs.
"The software serves as a reminder for the specific elements I need to document to charge a level 4 consult," Dr. Lyon said.
Options and costs
Charge capture systems come in a wide range of complexity. Features—and prices—depend mainly on whether you want to use the software as a guide to accurate coding or for more complex operations, such as sending charges electronically to your practice management system.
Many software vendors target practices of 25 physicians or more, though some cater to smaller practices. The Charlottesville, Va.-based PocketMed, for example, focuses primarily on three- to five-physician practices and offers what it calls an entry-level system.
PocketMed's software provides CPT codes, but not diagnosis codes. Physicians generally print out the charges or send codes electronically to a clerk, who enters them manually into the billing system, said PocketMed founder Scott Strayer, MD, a family physician and assistant professor of family medicine at the University of Virginia.
MD Coder from Houston-based Mobile Design Technologies, however, helps you match the correct diagnosis codes to your CPT codes. As soon as you choose a CPT code, a list of the appropriate corresponding diagnosis codes appear on the PDA screen.
Like some other vendors, Mobile Design Technologies can create an "interface" between its software and some existing billing systems so that codes do not have to be manually reentered. Another vendor, NextGen Healthcare Information Systems in Horsham, Pa., said it has created interfaces with close to 30 practice management systems.
The simplest and cheapest way to send information is to hot sync your handheld to your personal computer. A number of vendors, however, can set up systems that allow you to wirelessly upload charges to the billing office as soon as you walk into the clinic.
Costs vary according to the complexity of the software, the number of physicians in your practice and the number of features. PocketMed charges a one-time fee of $95 per physician, while Mobile Design Technologies charges up to $1,000 per user per year depending on whether you want software just for coding or for electronic charge transmission as well.
MedAptus charges $250 per physician per month for its Charges in Hand system, with additional up-front fees for installation and training that vary according to practice size and system complexity. A practice that has between 10 and 25 physicians, for example, would pay up-front costs of $12,500 for a fully-integrated system.
PatientKeeper, which builds systems for only large hospital-affiliated practices, declined to quote prices, saying that it customizes fees according to the number of physicians and interfaces required by practice management or billing systems.
Ease of use
The prospect of using the PDA to improve billing accuracy and speed may be attractive, but is palmtop computing as convenient as whipping out an index card? The answer seems to be yes—once physicians get used to using the software.
Lahey Clinic gives its physicians about an hour of training on the software, said Cynthia Trapp, the clinic's director of coding and coding education. "Then it takes them a few days to a week to get used to using it," she said. "It's not difficult at all."
Charge capture software often permits patient lists to be loaded onto the PDA automatically when a physician hot syncs to an office or hospital computer. Physicians then choose codes by selecting items from drop-down menus, a process that PDA users refer to as "tapping."
MDeverywhere promises physicians that they will have to make only five "taps" from start to finish during basic encounters: One tap on the patient's name to open the encounter, one tap on "next" if the diagnosis has not changed from the previous visit, one tap to indicate type of visit (such as established patient or consult), one tap to choose a level of care, and one tap to select "done" and finish the procedure. The next time the physician syncs the PDA to a personal computer, the charges are sent to the MDeverywhere system off-site and then routed to the practice's billing staff.
Additional taps may be necessary for a new patient or diagnosis, or if you've entered a code that will likely be rejected by an insurer. That can happen, for example, when you forget to include the name of the referring physician in the case of a consult.
St. Louis University's Dr. Griffing said it takes about 30 seconds to document an encounter using the MDeverywhere software. That's about the same amount of time it once took him to check off boxes on a paper encounter form.
"When you see a patient, you call up your schedule, then select the patient, the diagnosis and the level of service, whether or not a resident is present and the procedures that are done," he said. "Then you close out the encounter. It hasn't changed what I do, it just lets me get paid for it sooner."
Applications to improve billing and coding
The following billing and coding applications include inexpensive stand-alone products that have limited uses and software that can connect to larger practice management systems. For a more complete list of software for personal digital assistants (PDAs), see our Buyer's Guide.
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ChargeKeeper
ChargeKeeper allows users to enter patient diagnoses and charges at the point of care and looks for coding errors. The program sends charges to billing staff and flags charges with "fatal errors" and puts them in a holding area. Can be integrated with hospital databases and patient scheduling systems. Available for Palm- and Pocket PC-based devices; contact PatientKeeper for pricing information. -
Charges in Hand
Charges in Hand helps physicians select CPT-4, ICD-9 and HCPCS codes, links and modifiers. The software, which runs on the Web or on a practice's computers, reviews physician charges against national and regional Medicare billing guidelines. An "enterprise" edition for larger practices can be integrated with scheduling, registration and billing systems. Runs on Pocket PC-based devices; contact MedAptus for prices. -
EveryCharge
This Web-based software synchronizes palmtop computers with practice management systems to put outpatient schedules and patient information on physicians' PDAs. Users can enter common diagnoses and procedures by hand or using bar code technology. The software identifies billing errors and sends complete charge information to users' billing system. Available for Palm- and Pocket PC-based devices; prices start at about $300 a month per physician. -
MD Coder
MD Coder offers a series of applications to help physicians capture CPT and ICD-9 codes at the point of care. Some products are bundled with the company's E&M DocuMentor, which helps physicians choose levels of service. Available for Palm-based devices only; pricing starts at $199. -
PocketBilling
PocketBilling allows physicians to code E&M services and procedures and track patients. Users can enter information on allergies, diagnoses, medications and past surgical history. Available for Pocket PC- and Palm-based devices; $49.99 -
Stat E&M Coder
Stat E&M Coder detects chronic overcoding or undercoding, counts documentation elements during dictation, and structures dictations to comply with E&M guidelines. Available for Palm-based devices only; $75.
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