I Want My Life Back

The SuperbillOptimizing Charge Entry and Problem LookupMartins Point Health CarePortland Maine

The Challenge• Overcoming the inefficiencies of charge entry– Can take 3-5 minutes depending on complexity• Overcoming the inefficient Problem lookup– Finding the right ICD-9 Code and description istime consuming and imperfect.• ICD-9 codes attached with certain charges areoften incorrect or require considerableadjudication in Billing.

The Solution• Adjudicate charges through a form using the“MEL_ADD_ORDER” Function• Store most popular problems/ICD-9 codes inan array embedded in the form (~1800 entriesin Library).• Automate the generation of ICD-9 codes withcertain charges.

Results• Charge entry for a typical office visit(containing E&M, lab, imaging, immunizations,RTO) reduced from 3-5 minutes to < 40seconds typically• Adding problem to problem list reduced from1-2 minutes to < 20 seconds• ICD-9 Codes now correct >97% in certaincharges (ex. Vaccination Charges, etc.)

Quick Review of Form• 3 tabs for charges:– Main tab (for Providers)– “More Stuff” tab for categories of charges– Clinical Support tab for CS Services, charges

Main Tab -- Providers• 4 columns– Services, RTO– Tests– Imaging orders– Problem List and Search Function• Lots of execute buttons– Placed for convenience– Color coded

Process• Pick a problem• Pick a or set of services• Pick a or set of tests• Pick a or set of Images *(Reason)• Create RTO if needed

Problem Search• 1800 “most popular” problems• Customized descriptors• Autogenerate “Well Patient” Codes• Quick request process for new problems• Autocheck problems as they are generated• Amenable to ICD-10 conversion

Automation• Autogenerate problem attachments for wellvisit codes• Autogenerate problem attachments forvaccinations• Autogenerate problem attachments forscreening tests or services• Require specific instructions for certaintests/services.

“More Stuff”• Allows menus of services, tests, imaging bycategory of symptom or disease.

Clinical Support Tab:• Vaccine charge administration• Clinical Support Services, Tests• J Codes

Customization of Menus• By age• By location of care• By gender• Allows groups of providers to have their ownmenus• Allows multiple service providers (differentlabs, imaging centers, etc)

Building a menu….• Menu Building form• Customize menus primarily to Document’slocation of care, patient age, gender.

The MEL_ADD_ORDER Function• Requires:– Existing Order Type, Category, Order– Attached ICD-9 Code(s)– Attached ICD-9 Descriptor(s)– Order modifier (ie 25, etc)– Order Instruction• Does NOT sign off orders• Does NOT support referral orders

Going Forward…..• Procedure Tab:– Lacerations– Cryotherapy with Dx’s– Lesion destruction/removal• ICD-10 (2012-13)