Practice Management Alert

An electronic medical records system may seem as if it has more to do with practice operations than billing processes, but changing the way your practice documents care can radically improve billing performance. Electronic medical records (EMR) systems are software applications that assist physicians and nurses in documenting patient care and that replace paper medical records for patients. They also have a number of other features, including built-in billing systems or interfaces with your practice management system. There are hundreds of EMR systems available, according to a survey that appeared in the January 2001 issue of Family Practice Management. Because the technology is relatively new, these systems have a few different names they may be referred to as EMRs, electronic health records (EHR), or computer-based medical records.

Practices often find they can use higher codes when they use an EMR because they have clearer documentation of what they did during a patient visit, says Robert Miller, PhD, an associate professor of health economics at the Institute for Health and Aging at the University of California, San Francisco. Physicians are still responsible for coding according to E/M guidelines, but industry experts find EMR systems improve the documentation that supports codes and, therefore, lead to more accurate coding. Miller is preparing a report on the use of EMRs in physician groups for the California Healthcare Foundation. The report will be released later this year.

A perfect example is E/M coding, says David Bond, executive vice president of A4 Health Systems' ambulatory division in Cary, N.C. He says most physicians are undercoding E/M on 10 to 20 percent of patient visits because they don't have the documentation to support the code that is appropriate for the services provided. The A4 system includes an E/M calculator that reads through the note and then suggests a code for the visit. Physicians feel more comfortable coding higher E/M codes when they know they have adequate documentation, Bond argues. Don't expect EMRs to change the way you code. Your physician must still know and understand E/M guidelines, and those guidelines are the same whether your patient charts are electronic or paper. Practices note an increase in higher-level E/M codes with EMR systems because their documentation is more complete. Thus, with better documentation, when higher levels of care are provided, the higher E/M codes are substantiated. Many systems capture procedure and diagnosis codes at the point of care (POC), which can really speed up billing, says Jim Collins, CHCC, CPC, president of the consulting firm Compliant MD and compliance officer for a cardiology practice in Matthews, N.C. "All of our claims will go out in about 24 hours," he reports. Without POC coding, Collins says, most practices can [...]