Lost Charts = Lost Dollars
As I travel the country looking at Emergency Physician practices, one common problem tends to surface. Missing/unbilled charts are a major source of lost income for most ED groups. When you think about the process, how hard can it be to copy and mail or scan all the charts for a date of service to your billing vendor? If only it were only that simple.
Common Pitfalls
ED physicians and ED billing personnel often oversimplify the idea of chart capture. Several common pitfalls occur within ED's that result in lost charts. First, you often rely on the lowest paid personnel, either hospital employed or group employed, to perform the one task that determines whether or not you get paid for your services. Second, many charts get out of the ED prior to completion by the physician or extender. Third, there is often no formal tracking process for missing charts. Lastly, responsibility for closing the loop has not been assigned or accepted.
How Do I Fix the Problem?
The fix to missing charts is not always a simple process and often needs continual tweaking. That said, here is how I would recommend you fix the problem. First, I would advise the ED group to employ or contract with the chart collation person. When these people work for the hospital, they have little or no vested interest in executing the job properly. Second, pay a little more to hire the type of person that understands the importance of the job, is organized enough to complete the job properly, and is thorough enough to hunt down all missing charts. Training is also very important. Spend time showing this person how to reconcile the charts sent to the billing company to the daily log.
Charts leaving the department prior to completion are always a problem. Most often, these charts represent admitted patients; however, this happens with other charts also. Research how and why charts leave the department prior to completion. My experience shows that the physician has signed the chart; therefore, they are deemed complete. I advise that physician hold off signing the chart until they have reviewed for completion. Remember that you are legally responsible for everything on the chart; therefore, I would not advise signing any chart until you have reviewed for completion and accuracy.
The importance of a formal chart tracking process can not be underestimated. If you utilize a management company, many already have this in place. For those of you who provide your own management, this process can be as simple reconciling the charts sent each day to the daily ED log. To complete the loop, make certain that your billing vendor has billed all charts submitted.
Responsibility for closing the loop on chart tracking should be established early. If you utilize a billing vendor, I believe the vendor has some responsibility for tracking missing charts. The best process occurs when your billing vendor works closely with your chart collation personnel to make certain that all charts are captured and billed.
What is the Cost of Missing Charts
The cost of missing charts to your group should be assessed immediately. Actual losses with vary from group to group depending on the volume of lost charts and your average recovery per chart. Listed below, you will see an example that I witnessed with one group recently.
EX: 36,000 Annual Visits
34,200 Annual Billable Visits
30,475 Actual Visits Billed
3,725 Missing/Unbilled Charts
$107 Avg. Patient Collection
$398,575 Annual Lost Reimbursement
Solution
Become very involved in your chart reconciliation process. Create a detailed process whereby everyone understands the importance, the methods to complete the job, and institute checks and balances with your billing vendor to make certain the loop is closed and all charts are recovered and billed in a timely manner. Remember, Attention to Detail is the key to recovery of lost revenue.