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 have charge lags of between a few days and a few weeks.

An EMR system can reduce errors and improve office efficiency, says Jay Hoey, MBA, chief operating officer of EMR vendor Impac in Mountain View, Calif. If you use a paper superbill, you have to do a lot of typing, he says. That takes time and necessarily includes miskeying a percentage of claims, he says. With an EMR, there's no need to key in codes because the clinician has done that at the POC.

The billing benefits aren't limited to claims going out the door practices see improvements on claim denials as well. There is no statistical measurement, but most practices also feel that they have fewer disputed claims with an EMR than when they were using paper, Miller says, because it's easier to keep track of what's truly billable.

According to a survey conducted by the Medical Group Management Association, out of 43 practices that had a fully implemented EMR about one-third received increased reimbursement from payers.

But that leaves two-thirds that had not increased their reimbursement, and Miller says practices shouldn't get taken in by rosy pictures. Experiences do vary, so it's important to get a wide sampling of opinion, he cautions.

If you pick the wrong electronic medical record system for your office, you could face angry physicians, decreased efficiency and system blackouts. If you choose carefully, you'll be bringing in more money and making patients and physicians happier almost instantly as well as keeping documents to prove coding compliance.

With hundreds of products available, it's important to find the best match for your needs, experts say. Thus, the first step is figuring out which features you want from an EMR system.

The American Academy of Family Physicians (AAFP) Ad Hoc Committee on EMR recommends that practices do a thorough needs assessment that defines exactly what they want the EMR system to accomplish. The committee recommends that practices consider and weigh seven benefits:

1. reduce medical errors
2. improve patient satisfaction
3. attract new patients
4. increase revenues
5. improve office efficiencies
6. improve quality of physician lifestyle
7. meet regulatory standards and requirements such as those in the Health Information Portability and Accountability Act (HIPAA).

More information about the Committee's recommendations or about EMR can be found at the AAFP's Web site: www.aafp.org/x432.xml.

Once you know which features matter most to your office, you can start looking at products. Start by contacting vendors or visiting a trade show at a conference you're attending. But don't take a sales rep's word on how good his or her product is: Ask for references, Collins says. If a vendor has a good product, then it should have business office managers who are willing to talk to you for 10-20 minutes on the phone.

You should be able to visit practices that are using the system, says Jill Burrington-Brown, MS, RHIA, professional practice manager with the American Health Information Management Association in Chicago. And if you can, try to get a visit that isn't vendor-controlled, she urges. That way, it will be easier to ask questions about the office's practical experience with the system, she says. Plus, it's always good to make sure you aren't the first customer, Burrington-Brown says.

These systems can be very expensive, but Burrington-Brown says you shouldn't trim costs in critical areas. For example, response time and processing speed are worth shelling out for, she argues. "If doctors have to wait, they are not going to be happy," she says. Since doctors are the ones who will use the system, you have to make it work for them. Otherwise, there's no benefit.

Look for a system that's intuitive, Burrington-Brown says. EMR requires staff to learn new routines while they are learning new software, she warns. She recommends finding a system that will make the transition the least painful.

Ask about interfaces. Depending on the EMR, you could have built-in billing plus physician order entry and lab and pharmacy interface. Figure out what's essential for your practice and what can be added on later. $ $ $