Introduction
Anesthesia groups commonly provide services at multiple facilities ranging from paper-based surgery or GI centers to large facilities with fully integrated EHRs. Consequently, the RCM processes for these groups too frequently relies on a paper form for charge capture, and the process of printing face sheets and sending a paper packet to billing headquarters is terribly inefficient and insecure. Charges inevitably go missing as reconciliation becomes a confusing mess. The practice finds itself at the mercy of their RCM vendor to provide service reports, and MACRA compliance becomes a distant after thought. Perhaps most importantly, control of data gets lost in a paper-based workflow, and thus forfeits a significant competitive edge.

Getting an electronic charge (claim) capture solution in place may not be as difficult as you think. In this article we review four advantages of abandoning paper, as well as the technical implications one should consider prior to making this leap.

Why adopt Electronic Anesthesia Charge Capture?

1. Cheaper

  • No more couriers – Claims are immediately available for processing.
  • Automated Demographics – No more need for face sheets, data entry fees, or typos.
  • No more handwriting – Once legible, no one needs to “hunt down” a provider for clarification.

2. Easier

  • Real-time claim completion – Providers will immediately know if any required data is missing.
  • More timely case reconciliation – Reconciliation may immediately follow the day of surgery.

3. More Intelligent

  • RCM independent – Cross checking the RCM company provides confidence in their performance.
  • Integrated dashboards – Operational scorecards allow groups to measure and report the value of the service they provide.
  • Daily analytic emails – Automated reporting of outcomes enables timely reactions to anomalies.
  • OPPE/Credentialing reports – Take advantage of collected data to help the hospital maintain Joint Commission certification.

4. Increased Revenue

  • Fewer lost charges – There’s simply no paper to lose.
  • More non-time based procedures – Making it easy to correctly document services ensures nothing is overlooked, including associated modifiers.
  • Out-of-OR Charges – These can add up and are too frequently ignored because they are difficult to send to billing company.

Technical Aspects: Is Electronic Charge Capture Right for Your Group?

When considering an end-to-end electronic charge capture solution, the clinical data collected at the point of care represents only a subset of the data needed to file a claim. The patient’s demographic information, including insurance policy numbers, full name, date of birth, gender, etc. are required and will exist within your Facilities EHR at the time your patient checks in for admission. Additional consideration should be given to how this data will be shared with your RCM partner and hopefully integrate with their software.

With over 170 integrations in the anesthesia market place, we often hear the same questions. Listed below, we offer some answers and hopefully our experience will shed valuable insight to help you move off your paper forms and recognize software efficiency gains for your practice.

Frequently Asked Questions

What’s the difference between an Encounter Number and a Medical Record Number?

When a patient is being admitted at your Facility, a data entry clerk will record the patient’s insurance data into the hospital EHR. In fact, your Facility EHR will not print patient stickers or wristbands without first capturing as much insurance information as possible. This data will then be associated with a single “Encounter Number” (sometimes also referred to as a “visit number” or “account number”). The same patient will then accrue multiple Encounter Numbers as they have multiple admissions and discharges from your Facility. The superset of all these Encounter Numbers are then referred to as the Medical Record, which has its own Medical Record Number. Because insurance coverage may change during admissions, it’s important to capture the Encounter level detail.

In an outpatient surgery center setting, it is common to find that the EHR is nothing more than an office-based appointment scheduling platform that uses an Appointment ID as the Encounter Number, and Patient ID as the Medical Record number.  This paradigm is conceptually the same as described above.

How does my billing company get the patient demographics (i.e. insurance information)?

In a paper-based workflow, the anesthesia provider will typically send, via fax or courier, a printed face sheet that includes all insurance data associated with the admission. This face sheet includes a unique Encounter Number which may be referenced later in the event your RCM vendor needs to check for insurance updates.

In an electronic workflow, your facility sends this data in a standard HL7 format referred as an “Admission, Discharge, and Transfer” (ADT) feed. This may be sent in real-time as the patient is being registered, or it may be sent in a batch format at certain times throughout the day. If the host EHR is an appointment scheduled system, it’s possible that the ADT feed must be supplemented by an SIU interface in order to capture all necessary information. In either case, the such interfaces are among the most basic and available from a Facility EHR. With agreeable partners, an interface can be activated within 2 hours. Unfortunately, we occasionally find EHR vendors who impose economic barriers to 3rd party integrations, which is nice way of saying they charge excessive fees to discourage competition. The Office of Civil Rights is actively monitoring this unhelpful practice and issuing fines when needed. We frequently see such behavior curtailed when Facility leadership intervenes on behalf of the anesthesia practice.

If an ADT is not an option at your Facility, you can still adopt an electronic solution which takes a photo of the patient’s face sheet. While not ideal, there are still benefits to be gained, especially if this is only a “stop gap solution” until a formal demographics integration is approved and in place.

Is an ADT feed required for an end-to-end charge capture solution?

Not necessarily. If you have a real-time ADT feed in place, then scanning a patient’s barcode with your iOS software will open the patient’s chart, thereby showing all of the demographic information (name, date of birth, gender, etc.). If no ADT interface exists, however, then you can easily create a chart with ONLY an Encounter Number. You will then need to take a photo of the face sheet, so that your billing team can manually add the required demographic information. So, while a real-time ADT feed is quick and affordable, it’s not absolutely necessary. In its place you can simply scan the patient’s barcode and take a picture of the face sheet.

What is the barcode on my patient’s wristband?

The 2D barcode frequently found on patient wristbands likely contains an encoded version of the patient’s Encounter Number. This is the unique identifier connecting a given patient to a wealth of data associated with a patient’s particular admission, including all of their insurance data. With an electronic solution, you’d want to scan this number to open or create a new patient chart in your software.

What if there’s no barcode on the patient’s wristband?

While the advantage of a barcode is to prevent human data entry mistakes, the anesthesia provider may still easily create a new patient chart “on the fly”. In this case, they need to be very careful to correctly enter the Encounter Number as printed on the wristband, and again take a photo of the face sheet.

Can we send the data from our Anesthesia module/EHR to our RCM vendor?

Technically, yes, but the devil is in the details. Getting the ADT feed is independent of using an EHR in the OR. So, all of the information above about ADT interfaces will likely still apply to this scenario.

In regards to interfacing with a Facility EHR to retrieve the required clinical data, including provider start/stop times, any additional non-time based procedures (e.g. arterial lines, regional blocks) and their modifiers (i.e. using ultrasound), comorbidities (i.e. ICD-10 codes), and especially out of OR procedures (e.g. emergency intubations) are much more technically challenging for legacy EHR vendors. The downside to such an approach includes increased costs, increased time (measured in years), and extreme inflexibility when either the Facility EHR updates or your specific data needs change.

It is far simpler, faster, and cheaper to perform duplicated data entry in your own mobile charge capture software. With the use of templates, duplicated data entry should take less than 60 seconds per patient encounter. This gives you the convenience of implementing now, maintaining the flexibility to change when needed, and most importantly avoids asking your hospital to incur the additional development costs of building a custom interface. We’d recommend using your political capital with the hospital leadership to implement an ADT feed which is extremely simple and standardized.

Do I have to interface with my hospital’s EHR (e.g. Epic or Cerner)?

Not necessarily. Keep in mind that having a real-time ADT interface is ideal, as it eliminates data entry errors, decreases incidence of denied claims, and reduces your accounts receivable. But it’s not required. If you’re using a paper charge capture process now, then adopting an electronic solution to scan your patient’s wristband, photograph the face sheet, photograph the anesthesia record, and enter your clinical data is still far more efficient and secure.

How do I handle Out of OR procedures?

With the right mobile charge capture solution, it should be easier to capture these charges as well. Too many times these services are ignored because “they don’t pay enough for the hassle”. However, when it comes to contract negotiation, it may be advantages to have an accurate count of all difficult IVs started on floor patients in order to illustrate your group’s “intangible” value and dedication to the hospital’s mission. Also, these procedures are reimbursable and add up over time. Capturing them is not difficult and ignoring these revenue just doesn’t make financial sense.

What if my facility only uses an EHR in certain locations with anesthesia service?

It is not uncommon for anesthesia services to be provided throughout the hospital, and they may not all be documented in the Facility’s EHR. This highlights the advantage of owning your own electronic charge capture solution. It frees you from the hospital IT team and allows you to practice where there is need and opportunity.

Can this data be sent to my RCM vendor’s software?

Definitely, and it can happen in 2 main ways.

(1) If you currently have a paper-based process, then this can easily be recreated by sending a PDF for each case to a secure FTP site. The RCM company would download the previous day’s cases and have complete, legible information to begin their manual claims creation and management process.

(2) While physical paper may have been removed with the above option, a larger benefit of being the mobile device based solution is realized after implementing a custom interface into your RCM vendor’s software. The larger RCM vendors will have interface specifications enabling the use of custom interfaces to import both demographic and clinical data into their systems and (ideally) auto-generate almost complete electronic claims ready for submission.

It’s true that not all RCM vendors or platforms are created equal, but our experience has shown that all of the above is possible.

How is MACRA compliance related to Charge Capture and my RCM vendor?

With your own charge capture solution, you’re in control of the data being captured on paper, iPhone or iPad. By adding very few fields to each case you may achieve complete MACRA compliance and earn easy bonus revenue. Additionally, you can provide your Facilities with quarterly Quality reports to assist their OPPE/Credentialing and Joint Commission needs. The strategic value of your data cannot be overestimated.

Can this reduce my billing fee?

Potentially. Depending on the level of integration coordinated between the Facility and your RCM vendor’s software, they may observe significant reductions in their costs. These reductions in cost come from:

  • No more data entry
  • Fewer mistakes and claim denials to process
  • Complete and legible forms requiring no follow up with provider
  • Complete case logs eliminating complex reconciliation delays

Conclusion

Perhaps you’ve never considered the value of your group owning and operating your own anesthesia focused EMR. Whether you’re using paper for anesthesia records or using a major EHR in the ORs, it may be time to update your paper-based charge capture and leave your courier days behind.

There are many reasons to be fully electronic, and it doesn’t have to be expensive or difficult. Thankfully, times are changing. By using software designed for how anesthesia groups actually work, your organization may be able to dramatically increase their RCM efficiency while also gaining new insights into your operational excellence. The larger, national anesthesia companies continue to invest in their own electronic infrastructure as they recognize the importance of having a single HIPAA compliant, secure, and available platform to store all of their protected health information.