Pay attention to billing

Many times when a practice says it is paperless, it really means only the front office. All of the patient records are in the EMR, and incoming lab reports are scanned twice a day, but there’s still an entire department that combs through paper reports and shuffles paper files. If the front office can benefit from paperless efficiencies, then what about your billing department?

Although most practices send out electronic claims, very few take advantage of electronic remittance. The vast majority of practices are still receiving printed checks that need to be physically taken from the office to the bank for deposit. The problem is that a trip to the bank might not happen for two or three days — and sometimes not at all.

“We have talked to many offices where some staff member quits and the next person to come in opens a drawer and finds all these checks, thousands of dollars of checks that never got deposited because that person never had time to get to the bank,” says Moore.

Though not all electronic clearinghouses offer electronic remittance, many do. Medicare offers electronic remittance for its claims, yet only 12 percent of practices take advantage of it. Why have your employees waste time driving to the bank and standing in line when Medicare or your clearinghouse can do the work for them?

It’s an efficiency solution that Springfield Cardiology adopted right away. “We receive some paper EOBs from the smaller companies, but everything is done through electronic remittance and direct deposit. So we are really limiting the amount of paper on that side,” says Shaikh. They are also saving themselves a lot of time.

Moore also recommends that billing departments scan in any print EOBs they receive. “It’s one of those documents that always goes missing,” she says. Just as with patient charts, there is no sense in having employees waste time searching for a paper EOB when a digitized version can be accessed easily by everyone.

Rome wasn’t built in a day

All of these are good suggestions to increase your practice’s efficiency, but don’t expect that you can implement any or all of them and go paperless tomorrow.

“We are certainly not 100 percent paperless at this stage,” says Shaikh, whose practice has been live with an EMR for about six months. “I would say we have eliminated 50 to 75 percent of the paper we were using before we implemented EMR.”

In fact, the practice increased the amount of paper it was generating when it first switched to an EMR. “We didn’t have our fax server set up right, so we were printing letters and scanning them back in,” explains Shaikh. “We tried to plan the work flow as best we could, but until you go live … .”

Initial wariness was a contributing factor. Shaikh admits that physicians and staffers at his practice weren’t completely confident about their new system when it was implemented. “When we first started the project, we always generated some kind of paper because we wanted to have some redundancy,” he says. Once they felt sure of themselves and the new EMR, they shredded that temporary paper.

Your practice can also expect to keep paper charts for a little while. Although smaller practices might be able to scan all of their patient charts, larger and more established practices could find that idea time- and cost-prohibitive. That was certainly the case at Nassau Orthopedic Surgeons. Bonini knew the nine-physician practice had to come up with a plan for what it was going to do with its almost 4,000 square feet of patient charts before implementing it’s EMR.

The solution was to scan active patient charts. Staff pulled charts for all patients that each physician would see within the next two months and scanned those immediately. “When the doctor went live on his first day with the EMR, he had no crutch and was totally paperless,” says Bonini.

When return patients called to book appointments, their charts were pulled and scanned before they showed up at the practice. All scanned paper charts were archived, as New York state law requires medical practices to keep patient records for seven years. At the end of each year, the practice shredded expired charts, but that meant shrinking paper records slowly. By the end of the third year, about half of the paper charts were still there.