# EMR & the Billing Service



## MEDASSURE (Mar 11, 2010)

To all you Billing Services out there:  What is going to happen to off site billing services when the doctors want to purchase an EMR?  Must they bring their billing back to their office?  Can we still do billing off site and integrate the EMR w/our billing software? 

Just looking for some input....

Kim Jawidzik, CPC


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## cyndeew (Mar 19, 2010)

First of all, there are going to be providers that won't for whatever reason, invest in an EHR system. That's not going to change. And if they aren't concerned about Medicare payments, then it is a non-issue because EHR is only going to affect Medicare reimbursement through time, not other carriers.

Secondly, it is a huge undertaking and some office will not have the skill or manpower to implement an EHR system in the time frame allowed by Medicare. There is a very good chance that the timelines will be set back.

It may eventually change the dynamics of what duties a biller performs on an outsourced basis, but it is the opinion of many in this industry that outsourced billers will always be needed.

You notice I said EHR system and not EMR because an EMR technically is a system implemented in an office that does not communicate with other entities, thus not qualifying for the stimulus bonus.

With an EHR system, it will have to be certified (none yet), have interoperability with other entities, and will have to meet 25 objective criteria in order for a provider to qualify for the stimulus. Owning an EHR system won't qualify a provider, they must demonstrate meaningful use and there are percentages, like 80% of tests must be ordered and results obtained electronically to demonstrate the use. One cannot buy a qualified EHR system and not use it as required.

And since payments are based solely on a percentage (75%) of the previous year's Medicare earnings, some providers have already stated that it isn't worth the investment to jump through all the hoops to earn the bonus.

There are many vendors out there claiming their system will eventually meet the certification guidelines - before anyone spends a penny, they should at least wait until the qualifications for certification of an EHR system shake out. At this minute, that hasn't happened. And I wouldn't recommend purchasing anything that "will eventually" meet the standard requirements.

So you can see, there is a LOT to accomplish and not a lot of understanding of how it works or what's required. It's going to take some time, skill, money and commitment - it's not going to be easy for doctors to earn the EHR incentive, therefore, it's not going to affect outsourced billing in the immediate future.


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## Pam Brooks (Mar 19, 2010)

I think that in the short-term, small private practices will still require the services of an external billing contractor.  However, as a coding supervisor for a physician corporation with 90+ physicians who has been using EHR for over two years, I consider myself pretty knowledgable about what happens to the billing and coding status quo when providers begin to use electronic medical records.  I remember several years ago when the software was installed, and we shrugged off ugly rumors such as, 'we aren't going to need the coders anymore'.  The truth is, coders are still very much needed, but not in the same capacity as we were used before.  

Our EHR has a feature called "automatic charge pass through" that allows the CPT and ICD-9 codes to drop from the EHR into a holding tank prior to claim submission.  Billers and coders review this data to check on appropriate code-sets, modifier usage, and other issues that could cause claim denials.  We have some fairly sophisticated claim edits in place to catch any billing errors before they are uploaded to our clearing house.  The coders who used to look at every charge and manually post charges now all have other responsibilities, and unfortunately,  we need fewer coders to accomplish them.  There is very little manual charge entry, and even less manual payment posting. The entire revenue cycle can now be performed electronically, with very little manual effort and even fewer people-related errors, which reduces the need for front-end coding, charge entry, payment possting and A/R staff.   

Even if your clients don't purchase an entire practice management system, most providers who purchase an EHR would be very unlikely to also purchase an additional (costly) license for their billing service; and likely would opt to bring the billing in-house, so that they won't have to re-create everything on paper.   How many home-based billing services are going to be able to afford to purchase an EHR license for each of their accounts, not to mention the hardware and technical backup to support them?   I think that a savvy coder/biller who is currently working for a billing agency should sharpen their auditing and education skills, because the EHR is not foolproof, and there is room for compliance concerns and documentation errors, which coders can help alleviate.   Most operative notes can't be easily re-created by using EHR templates (yet), so surgical coders are still in demand.  

As much as we might hope otherwise, eventually there will be federal requirements for EHR implementation, so I would recommend that nobody keep their heads in the sand at the risk of being in the same boat as medical transcriptionists; in our facility, EHR has virtually replaced the need for all transcription except operative notes.  I do predict that as more physicians are financially enticed and eventually federally mandated to implement an EHR, the demand for an external billing service may decrease, but if you recognize that now, you'll have sufficient time to position yourself so that you will have the skills and abilities necessary to make a living in this field.   

This is a fast-changing field, but hopefully we'll all figure out ways to contribute our talents and expertise as technology changes medicine.


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