Completing encounter forms

“Collecting the money is out of my hands.”  How many times have we heard physicians express this sentiment, both as wishful thinking and as a statement of fact?    Physicians often overlook the most important step in the billing and collection process:  telling the billing office what services were performed and the correct diagnosis of the patient.  Performing this task well will speed up collections.

Here’s what happens in a typical office if the charge slip isn’t filled out by the physician completely:  The check out clerk must either leave her desk and chase down the answer right away or put it in a folder of charges to be followed up on “later.”  If she steps away from her desk, she leaves patients waiting for her.  She then interrupts the physician to answer the question.  Charges left in the folder to be posted later represent monies not billed or collected.  “When it’s quiet” or “when we get caught up” the check out clerk will call for the medical record, find the information needed to post the charge and then enter the procedure and charge into the computer system.  As well as delaying payment, this adds to the work-load in medical records and for the biller.

What can the physician do:  Take an extra 15 seconds per patient and carefully complete the charge slip.  Make sure that all services provided are checked.  Write down the diagnosis for the day’s visit.  Take the time to notice why charge slips are returned with questions--diagnoses not connected to procedures when multiple procedures are performed, questions about physical exams, post op visits—and fill those slips out more accurately.  Physicians can take 15 minutes a month to ask their billing clerk why charges are denied or can’t be posted from the charge slip. 

Many practices have reasonably tight controls and good billing practices for services provided in the office, however, charges for out of office services may slip through the cracks. The physician should provide the same level of detail (name, diagnosis, procedure code or description of service) as in the office.  The office manager should periodically look at the coding levels for out of office services.  It is not unusual for careful physicians to bill all of their hospital consults or admissions or visits at one level, rather than to take the time to bill appropriately.  It is wise to use any hospital-generated reports (consult notes, OR schedules, ER visit notes) as a double check for charges.  Charges that sit in the pocket of the physician’s lab coat can’t be collected.  If the practice notices wide variation in hospital or nursing home charges from month to month, someone should ask the question: are all of the physicians in the practice submitting their charges on a timely basis?

Cash:  Physicians can improve their cash flow by doing their part in the billing process.  The first step is their responsibility:  accurate, complete and on-time completion of charge slips.

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