Revenue cycle management remains high on every medical practice’s priority list. A critical point in the revenue cycle is ensuring that services rendered by the providers result in 100% of charges posted, accurately and in a timely fashion. Whether a practice relies on human data entry to post charges or an electronic medical record that passes charges into the billing system, it’s important to have strong controls in place to ensure that charges are not lost or delayed in posting and billing.
To help you reconcile services to charges and monitor charge posting for accuracy and timeliness, follow these four steps:
Retrieve charge tickets. The charge ticket will be the source (main) document in this process. Your practice-management system should allow you to print charge tickets for all scheduled office visits. Also create an out-of-office charge ticket, a sheet that tracks charges by your physicians when they work at an outside facility. Work with your hospitals, nursing homes, and other facilities to obtain daily lists of patients assigned to your providers.
Obtain access to a facility computer system to check daily for patients seen by your providers. Use admission sheets and consult requests to create daily encounters for your providers to use when outside the office. You can also have your printer automatically number your charge-ticket forms and hand each physician a batch to use when out of the office (remember to record the range of numbers).
Run a missing charge-ticket report. Physicians who carry a batch of blank, numbered charge tickets for use outside the office should report to you daily what numbers remain in their possession. In doing so, you’ll be able to manually track any missing charge tickets used out of office. Do this daily because it’s easier to retrace the provider’s steps for one day should a ticket go missing. For in-house, system-generated charge tickets, a missing charge-ticket report is available in most practice management software packages. Run it daily. Whether you post manually or pass charges via the medical record, have a staff member review and complete the charge.
Your system should allow you to run a report that shows any tickets without a charge posted. Investigate all missing tickets, whether manual or system-generated, to resolve any problems immediately. If there is a valid reason for an incomplete charge ticket (e.g., a lesion removal awaiting a pathology report before a diagnosis is billed), record that missing ticket and check it daily until it gets resolved.
Include a hash total report. Newer practice management systems will include a hash report. The hash report totals the CPT codes of all services entered into the billing system during a batch of charges. In turn, you can generate a report totaling all of the CPT codes documented on your encounter forms to ensure no code is entered incorrectly.
This is often more accurate than balancing against dollars placed on an encounter form when they appear on the computer screen while posting services. If you enter 99211 (office/outpatient visit for E/M of an established patient) when you should have entered 99201 (office/outpatient visit for evaluation and management of a new patient), you aren’t likely to catch the error when balancing against dollars, but it will show up in hash totals.
Generate a charge-lag report. Practice management systems record at least two dates when you post a charge: one reflects the service date, the other the date the charge entered the system. To monitor posting delays, generate a monthly report of service charges comparing the service date to the entry date. You can run the report by poster, provider, or facility. If any of the data found in these reports causes you concern, drill down to get specifics to fix potential revenue leaks.