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One of the major challenges in operating a facility is to oversee the coordination and potential expansion of its information systems. There are various health information systems available for coding and billing, each with its own set of advantages. I have compiled a list of some of the major health information system software packages and some major features of each type of system.
Admission/Discharge/ Transfer (ADT):
ADT software is used to pre-register, register, transfer and discharge patients who receive care at a facility.
Major benefit: This software enables you to generate a daily report listing all patients who underwent surgery on that date of service. This report can be used to ensure that all cases are coded for all surgical patients.
ADT software is user-friendly, and users typically do not need advanced training to operate it. Using ADT software streamlines paperwork. Most facilities only print the registration/face sheet, which "travels" with the patient and becomes part of the patient's medical record. The registration/face sheet contains the patient's demographic, financial/insurance, and chief medical complaint/reason for encounter information. All other information is "housed" in the ADT database.
Compliance Software:
Compliance software houses local medical review policies (LMRPs) and medical necessity guidelines for Medicare carriers (and some additional third-party payers, depending on the scope of the software).
Major benefit: When ASC staff register a patient for certain services, the diagnosis and procedure code information for the services can be entered, and the software will "flag" the account for violating the payer's medical necessity policies if the procedure code is not covered for that specific diagnosis code.
For example, suppose an ASC registers a Medicare patient for a septoplasty (CPT code 30520) with a diagnosis code of 470 (deviated nasal septum). The software will check if the Medicare Carrier for the ASC's location recognizes a deviated septum as a medically necessary condition for a septoplasty and flag it if it does not. It is not uncommon for medical necessity policies to vary from carrier to carrier. The user can double-check the flag by accessing the Medicare Carrier's medical necessity guidelines on the web at http://www.lmrp.net. However, the vendor should have a system in place to ensure that the software is always up-to-date and in agreement with the Medicare Carrier's current policies.
Automated Order-Charge Entry System:
This software allows the ASC to automate the capture of billing data such as charges, units of service, and revenue codes at the point of care.
Major benefit: This software may eliminate the need for hardcopy pre-printed charge tickets/encounter forms. Since charge code data varies from facility to facility, before the system is operational, a staff member must first enter the facility's charge code data into the pre-established fields that exist in the software.
Here's an example of how the software works. An operating room nurse can enter an ASC-specific charge code "789435" to generate the ASC's charge for an inguinal hernia repair after the surgery has been performed. The sofware will generate a charge of "$875.00" and a unit of "1". The CPT code "49505" that will be assigned by the coder will be reported next to the "875.00" and the "1" unit on the claim form.
Electronic Patient Data/Records:
These are software programs that provide facilities with online access to clinical data such as pathology and laboratory results, radiology results, transcribed operative reports, and transcribed consultation reports.
Major benefit: The availability of online clinical results and/or dictated reports will facilitate accurate and expedient coding and billing of ASC services.
For example, a user may enter a patient's medical record number of "123456," and click onto a window for "Operative Reports." The next window may display several operative reports by date-of-surgery that are on file for the patient. Once the patient record is selected, the transcribed operative report page(s) for that date of surgery will appear on the screen.
Clinical Data Abstracting:
This type of software allows facilities to capture and retain pertinent demographic, financial and clinical data for each patient visit.
Major benefit: The abstracting of outpatient data will facilitate the ASC's analysis of Medicare patient data for case mix information, clinical outcomes, and other elements such as performance improvement measurements.
Many facilities "abstract" the ICD-9-CM diagnosis and CPT/HCPCS codes reported for each patient visit. This data must be kept on file as part of the Medicare Conditions of Participation. Some accreditation agencies also require healthcare providers to abstract certain data elements, such as clinical outcomes data. In addition, many facilities generate ad-hoc and standard reports based on key data elements that have been abstracted for the patient. For example, the abstracting software may be used to generate a report listing the names, diagnosis codes, and procedure codes assigned for all patients seen between January 1 and June 30, 2002 with a diagnosis code of "366.9" (cataract) reported.
Billing System:
This software allows facilities to collect charges and submit billing data to third-party payers.
Major benefit: The ability to expedite the preparation and submission of claims data to third-party payers, which can lead to an increased turnaround time for payment of claims.
Billing system software packages are oftain interfaced with other software packages, such as compliance software or editing software. The billing system software itself is used primarily to collect charges, diagnosis codes, and procedure codes for each patient account. For example, patient Jane Doe with medical record number "123456" is registered. This patient receives numerous services on 06/28/02 when she undergoes a dilation and curettage. All of the charge code, diagnosis code, and procedure code data entered into the automated order/charge entry and clinical data abstracting software for this patient is automatically interfaced into the billing software, allowing the facility to generate a bill that contains information such as the following:
This information will appear in the appropriate designated fields on the billing/ claim form.
Next month, we will look at software systems for editing billing data, managing contracts, and generating standard and ad-hoc reports.
Admission/Discharge/ Transfer (ADT):
ADT software is used to pre-register, register, transfer and discharge patients who receive care at a facility.
Major benefit: This software enables you to generate a daily report listing all patients who underwent surgery on that date of service. This report can be used to ensure that all cases are coded for all surgical patients.
ADT software is user-friendly, and users typically do not need advanced training to operate it. Using ADT software streamlines paperwork. Most facilities only print the registration/face sheet, which "travels" with the patient and becomes part of the patient's medical record. The registration/face sheet contains the patient's demographic, financial/insurance, and chief medical complaint/reason for encounter information. All other information is "housed" in the ADT database.
Compliance Software:
Compliance software houses local medical review policies (LMRPs) and medical necessity guidelines for Medicare carriers (and some additional third-party payers, depending on the scope of the software).
Major benefit: When ASC staff register a patient for certain services, the diagnosis and procedure code information for the services can be entered, and the software will "flag" the account for violating the payer's medical necessity policies if the procedure code is not covered for that specific diagnosis code.
For example, suppose an ASC registers a Medicare patient for a septoplasty (CPT code 30520) with a diagnosis code of 470 (deviated nasal septum). The software will check if the Medicare Carrier for the ASC's location recognizes a deviated septum as a medically necessary condition for a septoplasty and flag it if it does not. It is not uncommon for medical necessity policies to vary from carrier to carrier. The user can double-check the flag by accessing the Medicare Carrier's medical necessity guidelines on the web at http://www.lmrp.net. However, the vendor should have a system in place to ensure that the software is always up-to-date and in agreement with the Medicare Carrier's current policies.
Automated Order-Charge Entry System:
This software allows the ASC to automate the capture of billing data such as charges, units of service, and revenue codes at the point of care.
Major benefit: This software may eliminate the need for hardcopy pre-printed charge tickets/encounter forms. Since charge code data varies from facility to facility, before the system is operational, a staff member must first enter the facility's charge code data into the pre-established fields that exist in the software.
Here's an example of how the software works. An operating room nurse can enter an ASC-specific charge code "789435" to generate the ASC's charge for an inguinal hernia repair after the surgery has been performed. The sofware will generate a charge of "$875.00" and a unit of "1". The CPT code "49505" that will be assigned by the coder will be reported next to the "875.00" and the "1" unit on the claim form.
Electronic Patient Data/Records:
These are software programs that provide facilities with online access to clinical data such as pathology and laboratory results, radiology results, transcribed operative reports, and transcribed consultation reports.
Major benefit: The availability of online clinical results and/or dictated reports will facilitate accurate and expedient coding and billing of ASC services.
For example, a user may enter a patient's medical record number of "123456," and click onto a window for "Operative Reports." The next window may display several operative reports by date-of-surgery that are on file for the patient. Once the patient record is selected, the transcribed operative report page(s) for that date of surgery will appear on the screen.
Clinical Data Abstracting:
This type of software allows facilities to capture and retain pertinent demographic, financial and clinical data for each patient visit.
Major benefit: The abstracting of outpatient data will facilitate the ASC's analysis of Medicare patient data for case mix information, clinical outcomes, and other elements such as performance improvement measurements.
Many facilities "abstract" the ICD-9-CM diagnosis and CPT/HCPCS codes reported for each patient visit. This data must be kept on file as part of the Medicare Conditions of Participation. Some accreditation agencies also require healthcare providers to abstract certain data elements, such as clinical outcomes data. In addition, many facilities generate ad-hoc and standard reports based on key data elements that have been abstracted for the patient. For example, the abstracting software may be used to generate a report listing the names, diagnosis codes, and procedure codes assigned for all patients seen between January 1 and June 30, 2002 with a diagnosis code of "366.9" (cataract) reported.
Billing System:
This software allows facilities to collect charges and submit billing data to third-party payers.
Major benefit: The ability to expedite the preparation and submission of claims data to third-party payers, which can lead to an increased turnaround time for payment of claims.
Billing system software packages are oftain interfaced with other software packages, such as compliance software or editing software. The billing system software itself is used primarily to collect charges, diagnosis codes, and procedure codes for each patient account. For example, patient Jane Doe with medical record number "123456" is registered. This patient receives numerous services on 06/28/02 when she undergoes a dilation and curettage. All of the charge code, diagnosis code, and procedure code data entered into the automated order/charge entry and clinical data abstracting software for this patient is automatically interfaced into the billing software, allowing the facility to generate a bill that contains information such as the following:
- Revenue code: 490
- CPT code: 58120
- Charge: $675.00
- Unit of Service: 1
- ICD-9-CM Dignosis Code: 233.1 (Cervical Dysplasia)
This information will appear in the appropriate designated fields on the billing/ claim form.
Next month, we will look at software systems for editing billing data, managing contracts, and generating standard and ad-hoc reports.
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