Electronic Health Reporter

Guest post by Rick Little, vice president of Client Services, MedAptus.

Revenue cycle management. Right now you’re probably thinking this term sounds like some fancy business school jargon, so why should you care about it? Isn’t that an accounting issue? What does it have to do with healthcare IT?

Well, a lot actually. Applying health IT resources to revenue cycle management processes is a must-do now as the Affordable Care Act, Meaningful Use and the looming ICD-10 transition swing into full gear. In fact, now more than ever, technology solutions are needed to drive correct coding and billing compliance for an optimized revenue cycle. Without it, your organization will struggle into 2014 and beyond.

Here’s a quick look at how charge capture and management software helped The University of Texas MD Anderson Cancer Center prepare technologically and financially for all that the ACA, ICD-10 and other initiatives may bring.

More than eight years ago MD Anderson identified electronic charge capture as a technology capable of providing financial, administrative, and compliance improvements.  MD Anderson Cancer Center is part of the University of Texas system and located in the heart of the Texas Medical Center. One of the largest employers in Houston, MD Anderson has more than 18,000 employees including more than 1,400 physicians, and served nearly 110,000 patients in 2011.

Back in 2004, when the organization identified improving its revenue cycle management as an initiative, here are some of the challenges it faced:

• A huge sprawling campus
• An in-house developed Electronic Health Record (EHR)
• Old legacy systems for scheduling and billing
• Limited use of order entry

Beyond automating and streamlining physician charge capture processes, MD Anderson also required its chosen software solution to integrate with its EHR, link together numerous legacy systems and drive reconciliation improvements across its many clinical areas.

MD Anderson began using charge capture and management technology from Boston-based MedAptus with 50 physicians piloting the company’s mobile Professional Charge Capture (Pro) in early 2005. After initial pilot results that demonstrated improved revenue and decreased charge lag, MD Anderson implemented MedAptus’ use across its entire enterprise. Today, more than 1,300 clinicians utilize Pro for their professional charge capture and management.

Since MD Anderson began using charge capture technology, many improvements have evolved out of their implementation. These include:

EHR Charge Entry

A vital component of the charge capture deployment at MD Anderson is integration with the hospital’s proprietary EHR, Clinic Station. Working together, MD Anderson and MedAptus created an interface directly within the EHR allowing providers to easily complete charging and charting tasks via a single sign-on and with the preservation of patient context between the two systems.  This real-time, simultaneous entry has reduced errors, improved compliance, decreased time-to-billing and driven personal efficiencies.

Inpatient consultation charges

As MD Anderson evaluated areas for improvement within its revenue cycle processes, inpatient consultation charges stood out as an area for review. To improve capture here, a new interface from the consult scheduling system capable of creating consult visits within MedAptus was implemented. As a result, consult charge opportunities can now be consistently capitalized on by providers and MD Anderson is able to reconcile for anything that may have been missed for appropriate follow-up.

Reconciliation tools

In looking for help with charge reconciliation, MD Anderson needed a solution that provided support staff with full transparency of activity. In general, this staff consists of those tasked with reconciliation and those responsible for charge accuracy (typically coders). Regardless of organizational role, using MedAptus, staff are able to view the number of charges expected, submitted and missing at the provider, specialty and location level. They can also view the status of submitted charges as they are worked and approved by the coder group. Coders leverage the almost one million rules embedded within the MedAptus application which include Medicare edits, NCDs and LCDs as well as MedAptus proprietary and custom rules.

Once charges have been submitted for back-office review, the MedAptus configuration at MD Anderson allows charges to be “stamped” with specific data elements that are important to financial reporting across the MD Anderson enterprise. Prior to MedAptus, administrative staff needed to manually designate fields such as billing areas or revenue centers. Charge management automation has led to better staff productivity and increased accuracy of revenue reporting around this task.

Given all of the areas along the revenue cycle that charge capture and management technology can impact … still wondering why enhancing revenue cycle management processes is an IT challenge?

Rick Little is responsible for the implementation of software products and ongoing customer support services at MedAptus, including the implementation of MedAptus’ software solution at The University of Texas MD Anderson Cancer Center.