Charge Capture: Case Study

While the Kentucky Medical Services Foundation was successful in converting users to the new platform, there were surprises along the way.

Two systems, six years and almost 300 users ago, the Kentucky Medical Services Foundation (KMSF) investigated whether or not automated charge-capture technology was a viable solution for its physicians. KMSF, a provider of billing and other administrative services for the more than 700 providers who deliver care across more than 80 sub-specialty areas, had little familiarity with the technology. Interested in its potential, KMSF initiated a pilot study, engaging a small group of physicians to determine if this type of mobile computing would add value to the charge-capture process.

Even though the trial solution lacked integration with scheduling and billing systems, necessitating data entry support, physicians reported that the hand-held tool was preferable to paper. As a result, the Lexington, Ky.-based foundation undertook a formal ROI study that demonstrated purchasing the system for a more widespread rollout would be worth the investment. KMSF is the faculty practice plan for the University of Kentucky College of Medicine, a component of UK HealthCare that includes two hospital systems.

Approximately three years after initial implementation, KMSF staff grew concerned by a lack of technological and functional enhancement to its chosen system after the vendor was acquired by a third party.

“While we had become accustomed to the fact that formal releases were sporadic, once we were informed that the product would not be made compatible with the latest Windows Mobile operating system, precluding our doctors from adopting smart phone devices, it was clear that we needed to investigate other solutions for charge capture,” says Darrell Griffith, executive director of KMSF.

A group comprised of physician, IT, billing and leadership representatives initiated the vendor review process. Upon identifying 10 potential vendors, the group distributed a request for proposal (RFP) that contained six stated goals for system and vendor selection: The technology meets the needs of clinicians and provides sufficient timely technical support; it captures all evaluation and management charges for inpatient and outpatient visits; it provides up-front editing capabilities to allow for accurate charge capture; it accurately and seamlessly captures charges into the existing billing system; it minimizes delays in charge capture; and it is compatible with existing and future systems within the UK IT infrastructure.

“It was quite interesting to see how much charge-capture technology had matured in the years since we purchased our initial tool. Functions such as wireless synchronization, messaging and real-time coding edits were far superior to our previous system,” says Peggy Halcomb, associate director of KMSF. “In the end, our committee made the recommendation to purchase MedAptus’ Professional Intelligent Charge Capture. This decision was largely based upon two positive customer site visits and interactions with actual physician users.”

Departmental Champions Selected

KMSF opted for a phased rollout of the new technology, starting with the conversion of all 200 existing charge-capture users. While KMSF maintained its multidisciplinary approach to implementation, the role of departmental physician champion was added to ensure adoption. Each champion would be responsible for aiding in system configuration – specifically, code shortcut design for rapid selection of the most commonly used procedure and diagnosis codes – as well as acting as both super user and a resource for any issue escalation.

While KMSF was successful in converting users to the new platform in only a matter of months, there were surprises along the way. “Implementing a more advanced technology, specifically the interfaces from our hospital and scheduling systems, was a bit more complex than we had estimated,” says Griffith. “We had no choice but to dig into numerous and disparate location codes, facility codes and provider IDs, performing a lot of translation work to ensure each of our 20-year-old systems was speaking the same language.”

Another surprise was the learning curve for physicians, especially where the majority of them had been active users of other charge-capture technology for some time.

Though KMSF has three more rollout stages to complete, comprised of several hundred additional users, the 260 clinicians that are currently live on the product are using a number of features, including enhanced communication with other caregivers and coding staff, access to comprehensive referring provider data and automatic prompting of physician quality reporting initiative (PQRI) data completion.

“Until this implementation, we had very limited participation in PQRI – there was just too much manual work involved,” offers Halcomb. “The current release makes it easy for our providers to document the required elements for Medicare patients as they are finishing charge entry.”

KMSF also has experienced a charge lag reduction that ranges anywhere from four to 30 days, improving cash flow acceleration. Neonatology, for example, previously held charges automatically for four weeks while waiting on updated insurance and/or Medicaid information for newborns. Now these charges are added to a work queue and automatically released when the insurance verification clerk has received the requisite information from the third-party payer.

Another benefit is streamlined reconciliation for both inpatient and outpatient charges, including those services rendered at regional off-site locations. The ability to review and analyze billed and unbilled charges is available not only to the providers, but across all administrative personnel within the clinical departments, as well as across the healthcare enterprise.

Better Use of Resources

This process has reduced the possibility of missed charges, Halcomb says, thus increasing the opportunity to maximize revenues. As a result, the clinical departments have been able to free resources from what they refer to as “heads-down charge entry” and redeploy them to higher-value activities such as front-line software support and refined front-office revenue cycle activities.

Another area impacted by KMSF’s system migration is that of improved charge-capture accuracy. Previously, a physician had to identify the place of service (POS) code on each patient encounter. If done incorrectly, this could lead to overpayment or underpayment. Now, POS is automatically linked to a location transmitted from the interfaces, thus improving compliance and allowing physicians to focus more on treatment and less on administrative work.

This technology has allowed KMSF to be innovative in several areas, including the ability to hold charges until a determination is made relative to a one-day stay. For example, if the status changed from observation to an admission, yet the physician has released a charge for observation, the held charge can be corrected appropriately by a coder prior to release of the claim.

KMSF advises that any group considering this mobile technology limit hardware options for clinician users. “With our first charge capture experience, we allowed clinicians to utilize practically any device of their choice,” says Griffith. “This led to a challenging support-and-upgrade situation for our IT staff. With our second try, we knew to limit mobile hardware options to those deemed by IT and the vendor to be best suited to the technology and most straightforward to maintain. So now we only support one PDA model and one smart phone, in addition to the Web.”

Halcomb also warns not to underestimate the change-management processes required for a successful deployment, especially when dealing with multiple, aging systems. “While a piece of new software can have the most wonderful bells and whistles, if you aren’t willing to invest the effort in optimizing internal and supporting processes, you will likely be no better off than you were before.”

From the Catalog

According to www.medaptus.com: MedAptus’ intelligent charge-capture solution eliminates lost and missing charges, streamlines inefficient processes, improves billing operations and drives cash increases. The Practice Plus Edition is one of six variations, offering a flexible, scalable charge-capture automation tool for single-specialty physician groups, multispecialty clinics and academic practice plans. The system addresses compliance audits, revenue loss from missing charges, elongated charge tag and lack of billing process transparency. The solution interfaces with virtually any scheduling, billing and registration system, leveraging existing IT investments and enhancing processes, without significant impact on workflow or patient loads.

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