"It can really make or break your whole edit process," Marino says.
Additional features
An ideal system should also be user friendly, customizable, and able to deliver reports to help practices improve their performance.
"I want it to be simple — click, click, done," says Gordon Moore, MD, a part-time solo family practitioner in Rochester, N.Y. He performs his own billing electronically — 15-20 claims per week.
"If I'm spending more than half an hour a week at it, something's wrong."
Moore likes the fact that his system does more than tell him that something is wrong or missing in a claim. He has customized his system prompts to provide him with correction options that he has selected based upon his particular patients. The software also "learns" from his past claims activity which claims will be paid or denied and why.
"I get drop menus for ICD-9 codes and CPT-4 codes, and the system knows that the diagnosis and the CPT-4 must be linked," he says. "I can even customize lists of diagnoses for patients." Moore also has tools to assist him with evaluation and management (E&M) codes. "I probably have uncommonly high coding for my type of practice, but I get away with it because it's all documented."
Many systems also provide reporting that allows users to analyze how well their billing processes are working. For instance, many provide real-time reporting on which claims have been rejected and why, and this information can be sorted by payer and type of claim. Additional reporting functions include account aging, which lets you know, by payer, who's paying on time.
To facilitate claims for patients with multiple insurers, another add-on is a secondary billing function, which electronically generates secondary claims, applies secondary specific payer edits, and provides explanations of benefits for each payer. Then those claims are automatically filed electronically.
"I was able to reduce my staff by two," Burress says. "Because they remit those files automatically, there's no more printing, folding and mailing."
Future advancements
The prevailing wisdom of a paperless medical practice is to control data as close as possible to the point of origination because all other processes (e.g., medical records and billing) depend upon the accuracy of the source data. That's why data origination and source documentation are thought to be the upcoming "hot" areas of technology for medical offices.
Voice recognition software can be used in place of paper documents and dictation, thus eliminating the need for paper charts and transcription.
Bar coding, which is already widely used to eliminate medical errors, could also be used for electronic diagnosis and procedure coding. Physicians could use a light pen to scan barcodes from diagnosis and procedure lists in the same way the clerk at the Home Depot can scan a barcode for the price of nails from a product list.
Currently, PDAs have the most software available to support coding and billing at the point of care. Some programs simply offer lists of codes; others can perform more sophisticated tasks like auditing physicians' coding for errors.
Prior to implementing any new technology, practices should evaluate their technology and processes to determine how they are related before making any changes to either. For example, practices that have experienced coding personnel who have been around for a long time may not need to invest in high performance software at this point. Practices where staff turnover is higher and billing staff may have less experience may benefit greatly from automated tools.
Technology, in Marino's opinion, is a means to an end. But by looking at tools and processes, practices can determine the best way to set up operations to accomplish goals instead of treating technology as an end in and of itself.
