Blog Summary
At facilities without an EHR interface, two steps tend to break down for physician groups: registering the patient and coding the visit. Most groups still do both on paper. Providers hand off face sheets, write codes on cards or patient lists, or email a practice manager who keeps a running list. Mallory Denomy, Business Development Manager at medaptus, describes both workflows and the five costs they carry: missed charges that leave no trail, late charges that miss HFMA’s three-to-five-day benchmark, duplicate manual work, couriering paper, and HIPAA risk from paper PHI. She offers a three-question check to find out how your group actually works. She then introduces Face Sheet Auto-Registration, part of Charge Pro’s mobile charge capture in the November 16 release. It registers a patient from a photo of a printed face sheet or a capture of the facility’s screen, flags likely duplicates, and lets the provider either code the visit on the spot or hand the registered patient to a coder.
“There’s no great process, and I’m sure we’re losing things.”
An operations leader at a 25-location physician group told me that this summer. Her providers were getting charges back from the hospitals where they round in two different ways. Some carried face sheets back to the office, and some emailed the manager to add the patient to a list.
If your providers see patients at sites where you don’t have an interface, two steps tend to break down:
- Getting the patient into your system.
- Getting the visit coded.
This post looks at how groups handle that today, what it costs, and what we built to fix it.
Two common workflows
The provider hands off the patient. The provider sends the patient information back to the office, and someone else takes it from there, registering the patient and coding the visit. Depending on the group, that might mean carrying face sheets back, sending them in batches, faxing them, or texting a photo to a manager. We spoke with a physician billing company that handles billing for nearly 10,000 physicians. Even at that size, some of their clients send over only an image, and their team registers those patients by hand. Outsourcing billing doesn’t make the work go away. It just moves it to someone else.
The provider codes too. The provider codes the visit, but on whatever is handy. One of our long-time customers described how their providers at non-interfaced sites write “99232” and a scribbled diagnosis on a hospital card, then hand it in later. Other common methods include printed patient lists, charge tickets, or an email to the practice manager, who keeps a running list to bill from.
Some groups run both, and it can look different from site to site.
What it costs
| Labor | Charge lag | Missed charges | Compliance exposure | |
|---|---|---|---|---|
| Face sheet in the pocket | Staff retype everything | Days – until the sheet comes back | Highest: sheets get lost or never turned in | Paper PHI leaves the building |
| Email to a list | Manager maintains the list | Depends on when the email is sent and read | Emails that never get sent | PHI in email and spreadsheets |
| Billing builds the patient | Highest: every drop-in patient typed in by hand | Grows with the registration backlog | Lower, but misread fields cause rework and duplicate records | Copies of face sheets kept outside the system |
| Batch to the office | Sorting and matching paper | Longest: nothing moves until the batch does | Whole batches can go missing | Paper PHI in transit |
Missed charges. Cards and face sheets get lost, and a charge that never makes it into the system is hard to catch. At these sites, providers often find out about patients through a phone call, a page, or a faxed list, so there’s often no single record of who should have been seen. With nothing to check against, a missed charge leaves no trail. There’s no denial to work, so it never appears in your denial or A/R reports.
Late charges. HFMA cites a best practice of capturing complete charges within three to five days of service, with late charges making up no more than 2% of all charges. Paper that waits for a batch or a courier can easily miss that. And with Medicare requiring claims within a year of the date of service, and many commercial payers allowing less, a face sheet found months later may not be billable at all.
Duplicate manual work. The same patient information gets written, carried, read, and typed again. Someone registers the patient by hand, someone reads the provider’s handwriting, and someone matches the two. Each step adds time and another chance for an error or a duplicate record.
Shipping paper. Couriers and staff driving stacks of face sheets to the billing office cost money and time, just to move information that already exists at the facility.
Compliance risk. Every face sheet is PHI. HHS says the Privacy Rule requires safeguards for PHI in any form, including paper. OCR has enforced this: in 2014, Parkview Health System paid $800,000 after paper records for 5,000 to 8,000 patients were left unattended in the driveway of a retired physician’s home. Face sheets in cars, courier bags, and personal phones carry the same kind of risk.
How to find out what you have
Ask three people the same question: a provider, your practice manager, and someone in billing.
“When one of our providers sees a new patient at a site where we don’t have an interface, what happens next?”
If you get the same answer three times, you’re in good shape. If you don’t, now you know where to look.
New in Charge Pro: Face Sheet Auto-Registration
The November 16 release of Charge Pro adds Face Sheet Auto-Registration, which lets providers register patients at non-interfaced sites from a capture of the face sheet.
The provider selects the facility and captures the face sheet in one of two ways: a photo of the printed face sheet, or a capture of the face sheet on the facility’s computer screen. Charge Pro reads the patient information and registers the patient. Anything that doesn’t read cleanly can be corrected on the spot or followed up later. If the patient may already be in the system, Charge Pro flags the likely match instead of creating a duplicate. The captured image stays attached to the patient so billing can check it.
It works either way your group does. If your providers code, they add the procedure and diagnosis codes and submit the charge before leaving the room. If your coders code, the provider can stop after the capture, and the patient is already registered and waiting for them.
What changes
- Missed charges: The patient is registered when the provider sees them, so the charge doesn’t depend on paper making it back.
- Late charges: Providers who code can submit before leaving the room, and coders get the patient right away instead of days later.
- Duplicate manual work: No one retypes the face sheet, and likely existing patients are flagged instead of registered twice.
- Shipping paper: Nothing to courier or drive to the billing office.
- Compliance risk: The face sheet is captured digitally and stays with the patient in Charge Pro instead of traveling on paper.
It’s the same app whether a site is interfaced or not. We’ll walk through both workflows in our November 18 webinar.
FAQs
Can we capture charges at facilities without an EHR interface?
Yes. In Charge Pro, any facility can be set up as a location, and providers charge from their mobile device whether or not there is an interface. With Face Sheet Auto-Registration, in the November 16 release, a provider registers a new patient by capturing the face sheet.
What does paper-based charge capture cost at non-interfaced sites?
The main costs are missed charges, late charges, duplicate manual work, the cost of shipping paper to the billing office, and compliance risk from paper PHI.
Do providers have to code the visit?
No. Providers who code can add codes and submit the charge on the spot. Or the provider can stop after capturing the face sheet, and a coder picks up the registered patient.
Does Face Sheet Auto-Registration work with face sheets on a computer screen?
Yes. Providers can photograph a printed face sheet or capture one displayed on the facility’s computer screen.
What happens if the patient is already registered?
Charge Pro checks for matching records when the face sheet is captured and flags the likely existing patient instead of creating a duplicate.
How do we find out which workflows our group is using?
Ask a provider, a practice manager, and someone in billing what happens after a provider sees a new patient at a non-interfaced site. If the answers differ, you have more than one process.
About The Author
Mallory Denomy is a Business Development Manager at medaptus, working with physician groups, hospitals, and health systems on charge capture, revenue integrity, and hospital medicine operations.
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