William Atchley, FACP, chief of the division of hospital medicine for Sentara Medical Group in Norfolk, Va., used to keep tabs on his billing the old-fashioned way: He carried around sheets of paper and stuffed notes into his pockets. But now when he rounds on patients, he inputs charge codes into his Palm Treo.
“Instead of carrying around pieces of paper, losing the paper, or forgetting to circle something or put down a code, it's just a drop-down menu, a couple of clicks and my charges are submitted,” said Dr. Atchley, who said the charge capture program from Ingenious Med, an Atlanta company, saves him about 30 minutes a day in paperwork. “The sense I have with talking to fellow hospitalists is that they all seem to be moving from paper to paperless in one way or another.”
Using a handheld electronic device to capture procedure codes is not new, but as the technology improves, the approach is becoming particularly appealing to hospitalists, who on any given day may need to keep track of 15, 20 or even more patients spread across different floors or units. Martin Buser, a partner in Hospitalists Management Resources, a consulting firm in Del Mar, Calif., estimates that 5% to 20% of services that are provided are never charged for, in part because hospitalists “work fast and furious and things drop by the wayside.”
“Hospitalists get extremely busy and sometimes forget to process a consult they have been asked to see or don't take the time to think about which CPT code is most appropriate and accurate,” Mr. Buser said. “By having a prompt system, it allows them to focus on getting the charges in on time and can show them the whole stay and what has been charged.”
The right technology
Mr. Buser, who advises hospitalist groups around the country, said a charge capture program won't magically lessen workloads or boost the bottom line unless a doctor embraces the correct technology for his or her particular practice. For that to happen, an electronic charge capture tool should be easy to learn and use, and be compatible with other programs that a doctor interfaces with, particularly as electronic health records (EHRs) become more common. Mr. Buser likes the charge capture features offered by Ingenious Med, PatientKeeper and InteHealth, but said there are other good ones, too.
The coding task is usually just part of a package of tools that doctors install on their PDAs to help track patients. With a few clicks, they might also be able to look up labs, check prescribing information, update the primary care or consulting physician, and even gauge whether they are meeting quality initiatives.
“Doctors need to consider, ‘What is the cost? What is the installation hassle? Am I going to be able to deal with the technology? Is this program capable of understanding the hospital's (IT) platform?’” Mr. Buser said. The features and costs of charge capture programs vary, so hospitalists need to investigate their options, he said. Some programs, such as ones offered by Ingenious Med and InteHealth, charge a monthly, quarterly or annual subscription fee per doctor; other programs, such as one offered by MDeverywhere, are sold as part of a comprehensive billing service that charges doctors a set percentage fee (see Table). In some instances, hospitals pay for the service; in other instances, hospitalist groups assume the cost.
Doctors whose compensation packages include incentive bonuses based on the amount of money they bring in may be particularly motivated to make the most of the technology. Mr. Buser said that when “you combine a simple yet accurate charge capture system with a properly designed incentive compensation program,” income can increase by 15% or more. One hospitalist group in the southeastern U.S. increased collections by 20% using a charge capture program, he said.
Consider your workflow
“You have to make sure that a program complements a doctor's workflow,” said Steven Liu, MD, a practicing hospitalist who is founder and chairman of Ingenious Med, which offers coding and billing applications that run through the Internet on desktops and various portable devices. He said physicians need to be comfortable with the “ergonomics” of the system they choose—some doctors find it awkward to do charge capturing on a PDA's small screen and prefer using a laptop or desktop computer.
Ingenious Med's program, IM Practice Manager, like some others, has a feature that prompts doctors, depending on what type of case they are handling, to fulfill the needed criteria to receive incentive payments through Medicare's Physician Quality Reporting Initiative (PQRI). IM Practice Manager works as a stand-alone system but can also be integrated with existing EHRs, hospital information systems, and billing software. According to Dr. Liu, hospital-based doctors who use the system increase their net revenues by $25,000 to $35,000 per physician on average. Ingenious Med charges doctors on average $1,700 to $2,000 annually for the service, which is less than the reimbursement that a physician would receive from PQRI alone, Dr. Liu said.
Jeffrey Pilger, MD, medical director of the hospitalist program at St. Elizabeth Medical Center in Edgewood, Ky., said he and his colleagues were missing a sizable chunk of their charges before they started using a system that used to be called Mercury MD and is now marketed by Thomson Reuters as Clinical Xpert Charge Capture, an extension of the larger Clinical Xpert Navigator system.
“We figured we were missing 5% to 10% of billing with the old way of doing things,” he said. Now bills are submitted to the hospital's billing department within a day or two, and more accurate and complete coding means added income for hospitalists since their compensation packages include financial incentives based on productivity, Dr. Pilger said.
But technology doesn't always fly. Russ Cucina, MD, assistant professor of hospital medicine and associate medical director for information technology at University of California, San Francisco, said his hospital medicine division tried a couple of charge capture programs, but the doctors didn't take to them. Dr. Cucina said physicians in private practice have a financial incentive to improve their billing practices, but that's not the case when doctors work for a set salary.
“After having gone through several rounds of education and various mechanisms to get hospitalists to be better at coding, we decided it was a failing effort,” he said.