Home Forums Discussions General Discussion Chart handoff questions, ESP for billing

Looking at AC a few times now, I am still not clear how best to streamline the handoff of the chart without it being cumbersome? ESPECIALLY, how do you hand off the chart electronically to your billing staff so they know easily that it is ready for them? For example, my current system which Allscripts is dumping works like this:
--under the 'plan' tab I can pick when I want to see pt back, I can type any specific pt Instxns that will print out with the pt visit summary from the front desk
Once the chart is saved and an icon is chosen the pt status on the schedule automatically changes to 'ready to discharge' alerting both my nursing staff and receptionist the pt is ready for them.

--there is a section on that same page that I can write orders for my nursing staff such as EKG, adacel check pox etc and without interrupting my flow the nurses can finish up with the pt while I'm seeing the next one
I don't see any easy way to transfer the chart seamlessly to the nursing staff or receptionist with AC?....

--from a billing standpoint, that same page has radial buttons for 'not ready to review' 'ready to review' (these automatically tell my biller that if it says ready to review she can go ahead and submit the claim even if the note is not complete on my end bc the other two buttons are for 'complete' and 'incomplete'...
It automatically keeps track of my incomplete notes so I don't miss any that need to be finished on my end (finishing the physical or whatever) but as long as SP(services performed) and Dx parts are complete and I've chosen the button for 'ready to review' it doesn't hold up the billing
How do users in AC transfer the note from the physician to the biller in an efficient way??
(Please don't say you use paper superbills or my head will fall off). ; ))

Patricia,

Hold onto your head. We have 9 docs in our office so it is a bit complex, but we have in house billers. I have customized my quick code section, and currently dictate/template and complete each note with each encounter and print to a paper generated AC bill of the encounter.
Once in awhile I may miss a modifier or vaccine code or need to add more than the alloted 4 ICD 9 codes so write on the paper generated AC bill.
But, am going to start with cute pdf and modify the AC generated bill through Updox (if need to) then route to a folder on the shared server in which Lytec ll is used for our billing.
Currently at the end of the day the paper generated bills are collected and handed to our in house billers the next day.
Once I start using cute PDF the inhouse billers can start inputting the data right away in real time as soon as I PDF it to the folder in the shared Lytec server.
This will improve efficiency a bit, but this is next on my to do list.
Right now works much better than circling on the old paper super bill, so if this does not pan out it won't be the end of the world for me.

Yikes--this is a HUGE disadvantage of AC from what I can see...what a time waster....

I do not understand your problem. I am signing off chart with diagnoses and billing codes which I customized. I am changing tabs sometimes on bling section choosing from either most common codes with certain diagnoses or from customized tab. Rarely I have to actually look up the code. Save and forward to biller.

Im evaluating the product...not a user. I haven't gotten a good sense of how well the chart flows from the provider to the billing based on 2 demos so far...seems on here that alot of users print paper superbills and those go to the biller (not sure why you would want to do this if you are paying to be EHR) or others as above saving files/forwarding files etc to biller which seems cumbersome and inefficient. Maybe I'm missing something obvious?

I forward signed chart with charges and codes to biller. No paper bill. Issue with amazing charts is what happens next. There is no practice management module. Up until this moment everything goes smoothly. I am not sure about previous post with 9 doctors. Why can't they do what I do?

Patricia,
You may know that you are looking at AC at an interesting time since the practice management portion of the program does not yet exist, and the company is in the process of deciding how to move ahead with some sort of integrated billing solution. There are some elements of billing software in the current version; there will be additional ones in V6.5 which will be available soon. Nonetheless, if you use AC, you should realize that it is primarily an excellent EMR. All current users have had to develop a system for billing beyond AC and there are many different ways to do so. None are ideal as none are fully integrated with AC.
Sometimes it is hard to imagine new workflows. I would bet that you will find that there are many things that AC does far better than your current Allscripts product; the juncture between performing the note and sending the bill may be an area that is more difficult. Or maybe not. Can you describe your billing situation a bit more so that AC users in similar circumstances might be able to offer more information? Will you outsource your billing or do it on site? How do you handle it now? Are you aware that with AC you can print a daily batch of invoices or 1500's, or do them individually?

Patricia,

We are a rather heterogeneous group, one e-clinical, 2 still paper charts, and the rest AC or transitioning to AC. Some circle the codes on the paper super bill, some do as I do.
Hopefully to streamline things for the office we can come up with a fairly homogenous system as time goes.
The billers like the AC generated superbills, easy to read and systematically the same with each AC provider.
I prefer to input as much of the data myself since my livelihood depends on it.
I am still a bit old school and prefer a paper record to have on hand if we ever get audited. But not averse to transitioning to PDF the AC generated superbills to the billers, in a folder that can be saved.
However, I do not quite understand how my system is a time waster. No matter what system you choose will you not have to input your data at or near the time of service whether using paper or PDF to send to your biller?
What I find extremely liberating is the ease of generating a superbill in AC done at each encounter. Whether it is printed to paper or a PDF is really a moot point in my opinion, other than having the billers start inputting data/scrubbing the bill for errors immediately instead of a day later.

Patricia,

To me, the time waster is not being done with your note when the patient and you leave the exam room. Since the beginning of this year, that has happened to me only twice I think. It would drive me nuts if I had to finish 25-30 charts every day.

I wouldn't recommend that you switch to another system unless you think there is a good chance you can spend less time on it. Pick the system that makes you the most efficient, and either see more patients or enjoy your lunch and evenings more.

For me, the nurse checks my plans for any orders and I have my own program that tells the lab what to draw, the front desk when to reschedule, and the biller what to bill. We use MediSoft so they can tenkey in the codes I send them before my nurse is in the room. My point is that there are many different ways of handling the workflow. Enjoy seeing patients!

Hi Patricia,
To answer your question from the other post, we use a paper superbill. In detail:

If the visit is a well child exam, the nurse circles "checkup" on the SB and all the vaccines we will give during the triage. If it is a sick visit, she circles "sick." Then she forwards the chart in AC to the doctor. We put the superbill on the exam room door. After the doctor has finished the exam, she looks at the paper superbill to verify that the nurse has circled the right codes (mostly checking the vaccines) and she may circle additional codes like strep test or additional vaccines that was given.

When the doctor signs off on the note (which may or may not happen at the end of the visit), she will select the E&M code from the quick codes screen - 99213, 99214 or the checkup codes. She then puts the paper superbill in the allotted location we have for "ready to bill." The biller takes this stack of superbills and find the pt chart in TotalMD. She looks for the date that matches the SB date. The visit code should already be in TotalMD because it links automatically with the signed note in AC. Then she adds/edits any additional dx or CPT codes that's on the SB to the bill. When there are vaccines, the biller always has to add vaccine & admin codes - the doctor does NOT pick the vaccine codes in AC. We have found that it's faster this way.

One thing I don't like about TotalMD is we can't see the signed off visits all on 1 screen. We have to know which pt chart to go to to see that there's a CPT code ready for billing. So there are times when a visit doesn't get billed because that paper SB mysteriously disappeared. However, TotalMD does have a way to create claims for all unbilled charges that have an insurance plan attached to it. So when you click that button, you'll get a bunch of claims made for all cpt/charges that are not yet on a claim, and then you can see if there are any charges you've missed with the paper SB.

Dan,

What is the program, you are referring to, which gives the nurses orders, labs? Would you be kind enough to email this?

Sunil,

It's one I wrote so cant help you there. I'm sure many others here have done the same

Dan