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New Generation Revenue Cycle Management: Accurate & Complete Payments

WRS Health recently produced a white paper titled, “New Generation Revenue Cycle Management: Not Your Grandmother’s Billing System,” which examines new, cloud-based revenue cycle management tools for medical practices. Today, in part two of our six part blog series, we examine the benefits of a fully integrated Practice Management, EMR and RCM database.

Part 2

It is crucial that your system is built on a single integrated Practice Management, EMR and RCM database so that you can get paid quickly and accurately for all services rendered. New generation, cloud-based RCM Systems include integrated charge capture and automated claim generation, all encompassed within an optimized, end-to-end workflow. When you perform the service, you chart your procedure and with the click of a single key, it is automatically queued for billing. This eliminates the inefficiency of paper super bills and need for dual data entry required with many “old style” billing systems.

Integrated E&M Advisor

Dr. Audrey Spencer said, “Our cloud-based system helps to make sure you are coding for the right level. Many doctors under code because they are afraid, but our system automatically determines the level of service you documented. All you do is click ‘okay’ and you can override it if you want to. You can change a level 3 to a level 4. The system definitely lets you code appropriately.”

No novice to entering billing codes, Denton Combs, CNP, in South Dakota said, “I’ve been doing coding for 12 years, so I already know what should come up. If it doesn’t, my system gives you a suggestion and tells you if you are missing things, such as one element of the exam. If it comes up wrong then I know I must have missed ‘this or that’ so I just fix it right away and it is done. I pay for someone to audit my charts every six months and I’ve been doing very well. Right now, we get five rejections a week. That’s a low number,” said Combs.

Dr. Lynda Wright was facing a dilemma. She was spending 45 minutes to one hour with nine to 11 patients every day, but she wasn’t getting paid nearly what she deserved for all of the services she was performing at OB/GYN practice in Kittery, Maine. Rather than reduce the quality time she spends with patients, Dr. Wright started using a Cloud EMR with integrated billing capabilities. “We have very few rejected claims. We are more likely to be using correct codes and using all the codes that we can use for a visit because of the prompts that are in our system. I have those additional prompts and can find specific ICD-9 codes to go with the condition rather than look through the book or try to find it online. That’s really helped,” said Dr. Wright.

Coding the Correct Level

Dr. Wright continued, “I’m certain my Medicare reimbursement has gone up. When we see a Medicare patient, there’s a level of service charge and because I’ve always been concerned that I’m not over coding, I am aware now that I had been chronically under coding for Medicare visits. With my system, having the ability to cross check that my level of service makes sense has allowed me to comfortably code for the time I’m spending, rather than under code. I usually spend at least a half hour, if not 45 minutes with a yearly type visit and I do a lot of menopause consultations, which are one hour encounters and I cover a lot of preventive territory with patients. If you’ve over coded the system certainly pops up indicating that you don’t have enough documentation to qualify for that code. This allows you to either add the documentation you haven’t bothered to put in that meets the coding or to reconsider your code.”

Coding to Prevent Audits

Being audited can be a harrowing experience. “Because of the way I practice, it was just a matter of being afraid to really ask for what I deserved from Medicare, especially because of the fear of being audited. Now I don’t have that fear of being audited because I can double check that I’ve met the standards through my documentation for coding in 99215 level of service for most of my visits. Before I was coding mostly 99214 and sometimes 99213 for visits that clearly qualified for a 99215 and the reimbursement is at least $25 or $35 dollars more for each one of those (99215) visits. If I do 10 of those visits a week, that more than pays for my system. At least I get everything that’s available to me because my system helps me to be comfortable that I haven’t over coded,” said Dr. Wright.