Content provided by ZOLL Data Systems
Creating a clean electronic patient care report (ePCR) that billers can use to efficiently progress a claim through its life cycle is the goal of every EMS agency. The reality is that routine documentation has pitfalls that often cause problems for both medics and billers. Medics have limited time to capture demographic and insurance information from the patient, and billers are then handed documentation with gaps and inaccuracies, making it difficult to submit a clean claim. This stymies the agency when trying to bill for the highest level of service and slows down the revenue cycle.
But by implementing these proven best practices, agencies can optimize ePCRs so medics can work faster while still providing billers with all the documentation they need:
1. Put a quality assurance and quality improvement (QA/QI) workflow in place.
Clean ePCRs mean faster revenue collection. To help ensure documentation is complete and accurate, put a prebuilt QA/QI workflow in place before ePCRs go to billing. When creating the workflow, it should answer questions like: Is all required information for your agency and NEMSIS included? Does any information contradict itself? Did you set appropriate data validations (closed call rules) and defaults with fail-safes in place for atypical situations?
It’s essential to start the billing process with clean charts containing all the necessary information to meet compliance and payer requirements, and the QA/QI workflow is the critical first step many agencies are missing. Without QA/QI, ePCRs may be returned to the medics who created them and bounce back and forth between departments – all the while increasing billing lag and hurting cash flow while revenue sits uncollected.
2. Leverage software integrations.
ePCR and billing software integrations can optimize the billing process and the QA/QI workflow along with it. For example, ZOLL Billing software comes with built-in revenue cycle management (RCM) optimization tools that offer demographic verification, insurance discovery, insurance verification, self-pay analysis and deductible monitoring. These integrations find, fix and verify patient and payer information to save billers time, reduce denials and increase collections.
“For instance,” explains Amanda Lee, implementation specialist at ZOLL Data Systems, “if you’re billing Medicare for a patient that has a junior or senior suffix on their last name, the ZOLL Billing tools can help you identify how Medicare has that patient’s name listed on file. This makes the documentation more accurate and satisfies all the different parties involved that are looking for accurate billing information.”
3. Paint a detailed picture with the ePCR
The ePCR should paint a vivid picture of what happened on the call and all the events that took place afterward, so your claim can paint that same picture for payers. You can’t bill for what is not documented, so ePCRs should capture as much information as possible to enable billers to bill for your highest level of service.
In the real world, crews don’t have much time, and details can be difficult to capture when focus is rightly on providing critical care to the patient. This is when you can use data validations (closed call rules) and chart defaults to guide medics through what information to capture to help paint that complete picture.
For data validations, determine what you want to require for ePCR completion and what is optional. You can choose to require correction, require special report or warn the user on different fields throughout the documentation.
You can also use ePCR defaults to make documentation easier and faster for crews. Set up your software so some fields default to display specific information every time. For example, utilize the defaults for a cardiac arrest event in which it’s established that one milligram of epinephrine is going to be given every three to five minutes for almost everyone in the country. Just be sure to put fail-safes in place that can override or give context to the defaulted fields. One fail-safe is the quick-action button present on every page of the ePCR that allows you to add time-stamped comments.
Using defaults and data validations to help crews do their jobs means billers get clear, concise, complete and accurate documentation that allows them to bill for the highest level of service.
4. Take time to teach staff how to complete ePCRs for agency success.
How can medics realize that something is important to document for revenue capture if they aren’t told? Educate both sides, billers and providers, on what ePCR information is needed and why. Show them the documentation required by NEMSIS, Medicare and commercial payers, as well as what your partners require.
This investment in education should happen proactively, setting expectations on what information needs to be captured for success across your organization and reactively when ePCRs are submitted with consistent mistakes. If a particular medic or staff member is repeatedly having to fix their mistakes or omissions, use their ePCRs as a teaching tool. Having this knowledge will ultimately make the process, from documentation to billing, easier on everybody.
5. Open communication between crews and billing staff.
Similar to educating staff on documentation, fostering open communication between crews and billing teams is imperative. The best agencies have staff who are comfortable saying, “I can only bill a BLS level of service instead of an ALS level of service because this ePCR is missing XYZ information” or “Can we talk about this documentation? It’s a little unclear, and there are parts that conflict.” When crews, administrators and billers can step back and discuss what is going wrong and how to improve the process, ePCRs will get better. And then the organization is more successful at reporting to different entities and submitting clean claims, improving revenue collection.
There are many ways patient care documentation can be optimized for billing success, from QA/QI and software integrations to internal education programs. If you’d like to learn more, watch the recent webinar, “Charting for Billing Success: We’re All on the Same Team,” now available on demand.