A few years ago I received an Amazon Kindle for Christmas. I was amazed and delighted that I could get any book I wanted to read, with the click of a button, while sitting on my living room couch. I found it lightweight and easy to tote around and the writing was clear even in direct sunlight. I was hooked.
After about six months, however, I found that there were moments when I just had to go to my vast inventory of hardcover and paperbacks and literally hold a book. I missed the feel and the smell of the paper, and the two-sidedness of something substantial in my hands. It was wonderful to simply flip a page if I momentarily lost concentration and I found that I was less likely to forget the characters within a real book than I was on books that were in my Kindle. Somehow, the touch of the book embedded the story in my consciousness, just as writing embeds a thought more firmly in your mind.
I found that I thought about this quite often while investigating different EHR systems. I would miss the feel of the paper chart, no matter how voluminous. The book-likeness of it gave you no excuse for a missing an insurance card or signature on file. I loved the physician notes scrawled on the cover, showing the last test or procedure and looking at the patient's chart somehow created a character that came alive with each turn of a page or flip to a progress note.
As ridiculously romantic as this is, and the fact that EHR is the wave of the future, the real possibility exists that we are reducing our patient's history to bits and bytes and opening the door to a carelessness that no one will notice. I completely understand its relevance to a history of treatment that is universal and can be transferred anywhere, and I do admit that clarity and organization is streamlined. However, I do know that the same process used prior to a scheduled day of patient care must also be utilized with any EHR system. I fear that a new laziness will come from using our computers for everything and that many employees will give themselves the illusion that our systems will now do the work that we painstakingly did by hand.
EHR systems come with enough bells and whistles that sooner or later, someone will come up with a program that allows you to examine the patient at home and send their medications though a slot in their PC's. For now, however, some basic rules should remain in place to assure that your revenue is steady and growing.
Your front desk staff should still print out a daily schedule and make sure that the following tasks are accomplished.
Check the patient accounts receivable and note any large outstanding balances and missed co-payments. The front office staff should never bully the patient into making a payment but rather suggest that a large balance shows in their records and perhaps they might want to check with their insurance company for clarification. Many physicians have patient responsibility balances that are mind boggling and find themselves without available cash when money is uncollected. The collection of co-payments at the time of patient check in is essential to assuring that every patient with a financial responsibility, honors that responsibility before the actual visit.
While you may have an EHR system that auto counts the number of visits left on a patient's referral, care should be exercised that the referral covers consultations and treatments. If you can view the actual referral in your system, this should be done prior to office visit for each patient. Authorizations should also be viewed to assure that procedures and tests are noted as code specific or your payments will be denied or reduced.
You should also verify the insurance for every new patient and re-verify the coverage of any patient who has not been seen in your office in the last 90 days. Patients change insurance coverage so often that gambling with their previously noted coverage will definitely result in loss of revenue. Be extra cautious with your Medicare patients. They often are not aware that they surrender Part B coverage when they enroll with a commercial Medicare plan. You should verify every Medicare patient prior to visit.
If your office provides such services as Physical Therapy or Acupuncture, you must note whether your patient's coverage provides reimbursement for these services and/or limits the number of visits each year. Restrictions on coverages or testing must be noted and should pop up in your system when you pull up the patient electronic chart or at least appear as a highlight in the patient's note section.
Physicians should take caution against relying on their EHR systems to determine the level of care provided and should guard against allowing the system to assign their diagnosis codes. Each physician should have a clear understanding of the Review of Systems and not necessarily allow their system to assign the highest coding for a quick follow up visit.
Let's face facts. The smartest physicians always had a billing sheet with procedures followed by diagnosis codes that would assure reimbursement. This is not news people. If you did an echocardiogram for a patient that was asthmatic and coded your claim for asthma, you would never be paid, regardless of whether the patient literally wheezed themselves to the point of death. Unless you noted a problem related to valve issues, you could argue until you were blue in the face and never get a penny in claim reimbursement. The EHR systems will do exactly the same thing. Specialty physicians will still use the same 5 or 6 codes that are acceptable, both to CMS and the commercial insurers or else they may as well hang up the white coat and study plumbing.
Despite all the new changes coming down the turnpike, and the urging towards uniformity in all things medical, the driving force for private practices will still be getting reimbursement for services rendered. While all our paper may now be in our computers, we will still need to do the same work to assure that we can afford to show up at the office each day and get paid each week.
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