Despite the push forward to electronic medical records, many physicians in my New York area are still using the old chart system. Some physicians are not even ready to e-prescribe and have told me that when the penalty matches the cost of the system, they will think about spending the money to update and participate.
I have implemented my "Daily Data Sheet" in the routine of many practices. It is available in an installment of this blog and has succeeded in increasing the amount of daily co-payments that are collected and has tried to assure that the amount of billing sheets matches the amount of patients that are logged in each day after they sign in for services. The purpose of the data sheet is two-fold. One is to prompt the front desk or check-in to collect the correct co-payment amount for each purpose. The second is to assure that each patient that signs in has an appropriate encounter for his or her visit. Herein may lie the rub!
Some physicians do not think it is a priority to finish their billing sheets each day and in some respects you can hardly blame them. With the cuts in reimbursements, more patient visits are required to keep the financial aspect of the practice on track. These means more patients and less hours in a normal work day. Secondly, the insurance companies are requesting patients notes for almost everything and this means that a short progress note, made in the chart, is no longer viable, even for the quickest of return visits. Consequently, for each minute that the doctor is dictating his patient notes, patients wait in the exam room or if the physician jots a quick progress note, with the intention of finishing his dictation after business hours, he may find himself without any other life but the one he pursues in the office.
This can present a serious problem, especially if the practice is farming its billing out to a service. The daily package often goes out incomplete. The physician reasons that if the majority of his claims go out complete, than he will catch up in a few days and this won't present a serious problem. Wrong !!!!
Your daily billing package should always go out complete or you will find yourself mired in paperwork with no end in sight. Your billing company will be contacting you daily or weekly to find out if the patient listed on the data sheet was seen and if so, where is the encounter ? If these issues are not immediately addressed, you will receive the same request from the billing company over and over again, and find your office pulling the same charts, copying the same letters, and sending the same notes again and again, wasting valuable time.
Saving five charts today means ten charts tomorrow and so on and so on, until the doctor is literally buried in unfinished work. An incomplete billing package means that encounters from June will be completed in August and this will have a cumulative effect on your daily revenue.
What's the solution? Short of taking charts home on the weekends, which many physicians do and which is not a good practice, or in keeping with HIPAA policies, the answer is to make time to finish all of your dictation the same day as you see the patients. Regardless of how you prepare chart notes, the doctor always knows what services he renders to each patient. Therefore, a completed billing sheet should accompany each patient exit. If notes are necessary, you can jot a quick progress note in the chart and mark the outside of the chart with a sticky note that will alert the physician that he has not dictated for this particular patient. For those truly fanatical physicians, you can make a copy of the encounter and mark it with a D- for dictation and place it on the outside of the chart, removing and disposing of it when the dictation is completed.
I have seen doctors keep a record of patient visits on the outside cover of the chart, noting special procedures performed. You could initial this medical log sheet every time you dictate on a patient and be assured that all work is completed. Those charts without an initial complete, can be placed to the side and dictated at a more convenient time in the physicians schedule. This outer chart logging of procedures also reminds the doctor when a patient needs a follow up test or procedure, without them having to explore all the chart pages individually. This method also serves to make life easier when calling patients to remind them that they need a return visit.
At the end of each day of patient appointments, the number of patients seen should equal the number of billing sheets that are turned over to be processed. While this may seem so old fashioned to those who are already entrenched in the spirit of the electronic world, it is essential to those physicians who have not yet made the leap. While so many doctors get comfortable in their old ways of doing business, the business world of medicine is leaving them behind. Whatever it takes to get the job accomplished and to prevent the duplication of tasks is mandatory if your practice is going to survive the health care changes that are here now and in the future.
I have implemented my "Daily Data Sheet" in the routine of many practices. It is available in an installment of this blog and has succeeded in increasing the amount of daily co-payments that are collected and has tried to assure that the amount of billing sheets matches the amount of patients that are logged in each day after they sign in for services. The purpose of the data sheet is two-fold. One is to prompt the front desk or check-in to collect the correct co-payment amount for each purpose. The second is to assure that each patient that signs in has an appropriate encounter for his or her visit. Herein may lie the rub!
Some physicians do not think it is a priority to finish their billing sheets each day and in some respects you can hardly blame them. With the cuts in reimbursements, more patient visits are required to keep the financial aspect of the practice on track. These means more patients and less hours in a normal work day. Secondly, the insurance companies are requesting patients notes for almost everything and this means that a short progress note, made in the chart, is no longer viable, even for the quickest of return visits. Consequently, for each minute that the doctor is dictating his patient notes, patients wait in the exam room or if the physician jots a quick progress note, with the intention of finishing his dictation after business hours, he may find himself without any other life but the one he pursues in the office.
This can present a serious problem, especially if the practice is farming its billing out to a service. The daily package often goes out incomplete. The physician reasons that if the majority of his claims go out complete, than he will catch up in a few days and this won't present a serious problem. Wrong !!!!
Your daily billing package should always go out complete or you will find yourself mired in paperwork with no end in sight. Your billing company will be contacting you daily or weekly to find out if the patient listed on the data sheet was seen and if so, where is the encounter ? If these issues are not immediately addressed, you will receive the same request from the billing company over and over again, and find your office pulling the same charts, copying the same letters, and sending the same notes again and again, wasting valuable time.
Saving five charts today means ten charts tomorrow and so on and so on, until the doctor is literally buried in unfinished work. An incomplete billing package means that encounters from June will be completed in August and this will have a cumulative effect on your daily revenue.
What's the solution? Short of taking charts home on the weekends, which many physicians do and which is not a good practice, or in keeping with HIPAA policies, the answer is to make time to finish all of your dictation the same day as you see the patients. Regardless of how you prepare chart notes, the doctor always knows what services he renders to each patient. Therefore, a completed billing sheet should accompany each patient exit. If notes are necessary, you can jot a quick progress note in the chart and mark the outside of the chart with a sticky note that will alert the physician that he has not dictated for this particular patient. For those truly fanatical physicians, you can make a copy of the encounter and mark it with a D- for dictation and place it on the outside of the chart, removing and disposing of it when the dictation is completed.
I have seen doctors keep a record of patient visits on the outside cover of the chart, noting special procedures performed. You could initial this medical log sheet every time you dictate on a patient and be assured that all work is completed. Those charts without an initial complete, can be placed to the side and dictated at a more convenient time in the physicians schedule. This outer chart logging of procedures also reminds the doctor when a patient needs a follow up test or procedure, without them having to explore all the chart pages individually. This method also serves to make life easier when calling patients to remind them that they need a return visit.
At the end of each day of patient appointments, the number of patients seen should equal the number of billing sheets that are turned over to be processed. While this may seem so old fashioned to those who are already entrenched in the spirit of the electronic world, it is essential to those physicians who have not yet made the leap. While so many doctors get comfortable in their old ways of doing business, the business world of medicine is leaving them behind. Whatever it takes to get the job accomplished and to prevent the duplication of tasks is mandatory if your practice is going to survive the health care changes that are here now and in the future.
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