Charge Capture System Overview

 

The MediScan Charge Capture System (MCCS) delivers unrivalled efficiency and revenue enhancement by substantially reducing data entry costs and payer reject rates, while maximizing and accelerating reimbursements. Our clients are obtaining impressive results with outstanding ROI rates. MCCS is tailored to the way that you do business. Custom designed forms support your current practices and needs, and application of standard, payer-specific and client-developed medical rule sets generates accurate and compliant claims.

 

MCCS extracts data from medical charge capture documents (encounter forms) and from other sources such as applications from laboratory, pathology, and radiology departments. Then, by applying generic and user-defined rules to these data to help validate items such as CPT codes, diagnostic codes, patient demographic information, and provider data, MCCS detects errors and omissions on forms and electronic data prior to submission to payers. "Cleaner" claims mean fewer rejections and less effort to correct and re-bill denials. MCCS applied rules also help satisfy Medicare and HCFA compliance requirements.

 

To enable our clients to take maximum advantage of MCCS, we provide full support, which includes provider training, department audits (CPT and Dx code usage) and charge capture form design. Our provider training goes far beyond form-filling instruction and includes topics such as the correct use of CPT codes, ICD-9 codes and attached modifiers. Combining provider training with the editing features of MCCS, greatly reduces the risk of claims rejection, under reimbursement, and audits.

 

We believe that the priority of the physician provider is treating patients. Implementing the automated data capture and data editing features of MCCS saves time, increases accuracy, and improves productivity, allowing providers to allocate more of their resources directly to patient care and to focus on their mission of health service delivery.

 

Charge capture forms are adapted to your current business needs and practices. To design charge capture forms, we conduct an in-depth analysis of the services and activities of each department. By reviewing previously billed services, we are able to guarantee that between 80 and 100 percent of the expected services will be available on the charge document for the current year. As it is often necessary to quickly modify a form or design one from scratch, we offer user-friendly tools that enable the customer to modify or design forms without assistance from MediScan. Other systems can read forms; however, they usually do not include such powerful modification and design tools with their software.

 

 

All data captured from the forms are collected and stored in an MS-SQL database for clinical outcomes measurement. Other data, such as HEDIS information, are also captured and sent on to appropriate agencies.

 

Rule sets which are applied to the captured data come from several different sources and provide several levels of analysis:

 

• The first level is examination of the data on the form. For example, every CPT must have an associated ICD-9; every injection must have units attached; and certain Medicare procedures require authorization.
 
• The next level is the application of rules developed by the client. This is how the MediScan System is tailored to the way you do business. For example, certain surgical procedures require the use of modifiers, which can either reduce or enhance revenue. Most cases result in revenue enhancement. Should the provider not use these modifiers, the system would advise management, and corrections can be made before requesting payment.

 

The last level is our integration with claims scrubbing systems. This integration has put claims scrubbing in a position of being a "front-end" process, as it will analyze the appropriate matching of procedure and diagnostic codes, perform error checking related to Medicare compliance issues, and apply user-defined rules, before billing submission to payers.

 

MediScan trainers will also provide suggestions that enhance reimbursement if it appears that potential revenue was overlooked. Wherever possible, ICD-9 codes are automatically submitted with a CPT code. For instance, age-appropriate preventive medical physicals will always be billed with an age-appropriate diagnosis code. Cerumen removal is always billed with a diagnosis of impacted cerumen. No additional effort is required on the part of providers to link a diagnosis with these services.

 

As CPT and ICD-9 codes must be updated annually, MCCS provides a quick search and replace function, overriding what may currently be printed on the form. This utility assures that the customer billing codes provided to payers are accurate and current, a key requirement for timely reimbursement. In addition, MediScan will add an encoder that will validate appropriate matching of CPT and ICD-9 codes according to HCFA and AMA rule sets.

 

MediScan has introduced a new feature: a pop-up ICD-9 dictionary which will allow the data entry operator on-line diagnosis code selection simply by typing the first few letters for a handwritten code description.

 

MCCS results are impressive. Palo Alto Medical Foundation has improved its revenue throughput by $1,000,000 per month (a 12% increase) and saves in excess of $250,000.00 annually through FTE reductions. This does not include additional benefits due to significant accounts receivable reductions, reduced time between date of service and date of claim submission to payers, and increased CPT and ICD-9 accuracy rates. The Foundation's pre-MediScan reject rate from payers was 12% and is currently less than ½ of 1%. The MediScan System is proven and has an outstanding track record. The implementation of MCCS translates into accurate and comprehensive billing and improved profitability.

 

 

MediScan also offers other features and benefits, such as high capacity storage, which maintains a picture of all charge documents. These documents can be quickly viewed or printed using several indexing criteria provided by MediScan. In addition, because all data are stored in an MS-SQL Server database, your organization can begin building files that enable you to perform physician profiling, and disease management and outcomes analyses.