Billing joins interoperability talk

Between the federal deadline regarding electronic health records and the shift toward accountable care organizations, the call for interoperability of EHRs has never been louder. Patient information should be able to flow freely, the argument goes, between physician practices and hospitals across town and around the country.

A second voice is chiming in, though not quite as loudly: Interoperability should extend to billing practices as well.

"We now have the EHR pushing charges into the billing system," said Mary Pat Whaley, a physician practice management consultant. "It's a huge issue for hospitals to try to decide how to make this happen in the most efficient way."

In the current environment, there is no shortage of medical billing systems. Sales and customer testimonials have pushed Kareo, eClinicalWorks, and AdvancedMD to the top of the market, according to Adam Sweeney, the managing editor of the medical blog at Softwareadvice.com. Kareo partners with Practice Fusion, a free EHR system, and recently launched an EHR service of its own. eClinicalWorks is one of the most widely used medical software systems, with over 70,000 physicians and 400,000 total users.

"There would be tremendous benefit in finding a way to merge the billing for the facility, and the billing for the physician," Whaley said. "The great inefficiency is that there are two separate processes going into the coding and billing for one procedure. And neither one has a good understanding of the other's coding and billing systems."

Might the shift from fee-for-service to quality and efficiency metrics change that?

"The ACO model is going to demand financial accountability from all of the players," said Jeffrey Cain, MD, the president of the American Academy of Family Physicians. "One of the things we're learning is the development of tools that provide financial decision support is just as important as the development of tools that provide clinical decision support."

Some organizations are moving in that direction, at least with the first step of standardizing EHRs. For example, when it comes to merging with physician practices, Whaley said most hospitals that use Epic's EHR replace a physician's current system with a scaled-down, customized version of Epic.

"Hospitals on Epic spread Epic," Whaley said. "It's a very smart strategy. And physician practices that agree to merge see it as the cost of doing business. They want the burden of management lifted completely off their backs.  They'll change their EHRs as part of the deal to get what they want."

But while Epic addresses professional coding and billing  -  or coding and billing on the physician side  -  facility coding and billing remains a separate entity.  

Though an imperfect situation, solutions do exist.

One would be to leave billing management to the professionals, argues Brad Lund, executive director of the Healthcare Billing and Management Association. Physician office managers might look over at the billing department, he said, and see a staff of three that is costing the practice $250,000 per year in personnel and systems for work that might require only two hours a day to complete.

"Fifteen to 16 percent of revenue is going to support the tracking of money," Lund said. A professional medical billing company, on the other hand, might charge 6 percent of collected revenue. That practice can save 10 percent a year using a billing company. "You don't have to have a nurse or receptionist doing coding at lunch or whenever time allows. People in a physician practice should focus on patient care, not the tedious and complex process of billing."

The current billing environment offers little incentive for change, Cain said. The demand for a secure but free-flowing system that allows for information transfer runs counter to the proprietary nature of the business software market. Any free flow of information is restricted to networks established through business partners using compatible  -  and proprietary  -  systems.

"It's in the interest of our country and our consumers that we find more efficient and effective care for our patients," Cain said. "If we don't do that, we're going to end up creating economic silos that will cost us the benefits that we're hoping will come from electronic records."