Practice Management Alert

Question: We have gone back through our records for a year to see if our physicians are billing visits accurately, and weve found that missing charge slips occurred daily, resulting in many unbilled visits and services. How can we eliminate this problem of charge slips disappearing?

Ohio Subscriber

 
Answer: You need to number your charge slips so you can keep better track of them. You should also examine the route your charge slips travel in your office to try to find out where the problem is occurring.
 
Many computerized practice-management systems automatically number the encounter forms, or charge slips, they produce. If your encounter forms are preprinted by an outside vendor, ask them to consecutively number your forms at the next printing. The forms can also be manually numbered. Each patient visit should be matched to a numbered encounter form. Many practice-management computer programs will create a numbering system for you and automatically associate the number of the encounter form with the patient. Then, when you call up the patient in the computer system, the encounter form number for each visit will be accessible.
 
If your practice-management system is not sophisticated enough to do that or you use preprinted encounter forms, or you manually number forms, when you print out the master schedule for the days appointments assign a numbered encounter form to each scheduled patient. Write on the master schedule the range of the encounter form numbers for the day. If you add patients to the schedule during the day, use encounter forms consecutively numbered after the number range for your scheduled appointments. This way, you can tell how many patients you saw during the day. Make sure you adjust what the end of range is for the day on the master schedule.
 
For example, if you have 60 patients scheduled for the day, you would assign encounter form numbers 1 through 60 to the patients and write the range 1-60 on the master schedule. When the first unscheduled patient of the day is added, that person receives encounter form number 61, the second receives form number 62, and so on. At the end of the day, the master schedule would contain the encounter form number range of 1-62, and the next days scheduled appointment would begin with encounter form number 63.
 
If youre setting up a manual numbering system, create something that tells you the year, month and possibly the day of the encounter forms. For example, instead of numbering encounter forms 1-62, try numbering to reflect also the year, month and day. Thus, form 020315-62, means the encounter was in the year 2002 on March 15. Numbering in such a fashion will help you later if you are looking for an encounter form by narrowing your search.
 
If your encounter forms are numbered, you can help account for them by checking during the day to see if the number of encounter forms you have matches the number of patients scheduled so far. If it doesnt, you can begin tracing the missing forms instead of looking for them later when they may be unbillable because the timely-filing date has passed.
 
Patients can be a big source of missing charge slips, or encounter forms. If your charge slips are handed in the exam room to the patient, who is supposed to take the form to the checkout area before leaving the office, its possible the form left the office with the patient. Look at the physical layout of your office and see if you can have the doctor, nurse or medical assistant deliver the form to the checkout desk. That eliminates the opportunity for patients to leave the office with charge slips, either by mistake or deliberately in an attempt to avoid paying the bill.
 
Having an office staff member deliver the charge slip to checkout can allow the practice to improve its customer service. Too often in many practices, when the patient arrives at the checkout desk, the staff member who is supposed to help hime or her has no paperwork on the patient. Meanwhile, the patient expects that the person at the checkout desk is going to know the reason for the visit and what needs to be done next. When the staff member delivers the encounter form to check out, the checkout person has a point of reference on the patient and can greet the patient, help schedule any follow-up appointments or tests, and ask for appropriate payment.
 
Trace the route of your charge slips in the office. If you discover bottlenecks, educate the staff on avoiding batching work, and using processes that more efficiently move the encounter forms to the billing department may help. For example, if the encounter form is still attached to the chart, and the chart is sitting on the doctors desk, you should discuss with the doctor the need to separate the encounter form from the medical chart and hand the form to the front desk so the visit can be billed.