Hayes Review: Summer 2009
Physician Charge Capture Module
Key factors to successful implementation
By Mike Tagliento
 Stand-alone charge capture solutions can be interfaced with many hospital and practice management systems as an add-on module or to complement the system’s existing charge capture functionality. Physicians appreciate a charge capture solution’s ability to provide a single view of patient data across multiple systems. Revenue managers like the ability to improve the charge capture process and reduce lag time.
If you have purchased a charge capture solution, it’s important to perform thorough pre-implementation planning before jumping to the installation process.
Where to start?
To get started, it’s helpful to determine the implementation rollout strategy. For example, if your organization was comprised of the following departments, which one should you roll out first?
- Dept. A – charge lag is 24 days
- Dept. B – charge lag is 14 days
- Dept. C – charge lag is 4 days
You might be tempted to choose Dept. A since the lag days are the longest. However, the fact that the lag is so long should raise suspicions about this department’s charge capture workflow. A new software solution can only enhance an existing workflow – it can’t change or rectify it. Process issues should be addressed before the rollout. It might be best to have this Dept. A go through a process review to find the root cause of the current charge lag disparity from the other departments.
Dept. B’s charge lag is in the middle (between A and C), but with a little research, we would find that it is the industry average. Therefore, the benefits of a charge capture solution may be most likely to be found here. Dept. C’s lag days are already quite low. Therefore, the benefits won’t be as dramatic, decreasing its attractiveness to other departments.
While expected benefits are one method to create a rollout strategy, you may also want to consider the number of users. Let’s say that Dept. B has 200 physicians while the others have 50. Should this change the rollout? In most cases, the answer would not change. As it happens, several charge capture solutions allow you to roll out in waves to physicians versus requiring all to go live at once.
How do I engage physicians?
You undoubtedly had physician leaders involved during the charge capture vendor selection. Don’t let them get away! Here are some suggestions for engaging physicians:
- Engage at least 3-5 physician champions for each departmental rollout
- Keep them involved at more than just the steering committee level
- Involve the physician champions in the physician setup process, helping to determine the number of charge capture days to display on a mobile device, whether or not to default to charge codes numbers on the pick list or how to set the initial view of the patient list, etc.
- Ensure that they are in the initial wave of physicians for departmental rollout
You’ll need your champions to foster goodwill and understanding among their peers as the next waves are brought live. Meeting their needs and keeping them involved will go a long way toward promoting a successful implementation environment.
Who else should be involved?
Representatives from IT, patient financials, clinical management, providers and the executive team should comprise your project planning team(s) to ensure a successful and efficient implementation.
Your core project team will include IT, patient financials, and clinical managers. This team will be responsible for completing system setup, testing and training. Strong representation from areas affected by the new charge capture solution will prevent rework in the end, as input will be obtained up front.
How much testing is really needed?
Robust testing is critical to successful go-live and adoption. Once your basic network diagram is completed, workflow test plans can be created.
Depending on your both your charge capture solution and your organization’s plans for mobile devices, you’ll probably use two inpatient test plans; one for physicians using the mobile device and another for web portal users. You’ll also need a set of plans for outpatient testing as well. These test plans should start at the feeder system level (i.e., Cerner, Siemens, GE, etc.) for patient ADT, scheduling and demographics. Then it should outline your steps for charge capture (web or mobile), and its output to the billing system. Be sure that the test plans include steps that are detailed enough to be completed but generic enough to be modified by the various departments installing the software.
Testing scenarios should be developed that can be used across all departments as their rollout wave moves forward. These should include scenarios that test basic system, interface and data functionality as well as output to the billing system. As each department begins its implementation, it should provide the project team with a list of department-specific testing scenarios that can be added to the testing list.
Testing workbooks need to be created as well. These workbooks will be used by the testing team(s) to track all of the data input and output. This would include the test patient name, insurance, charges coded, modifiers, etc., to ensure that all output to the billing system is consistent with the patient, insurance and charges. If possible, all billing output should be run to claims to ensure forms are generating and printing as expected.
Are there any other suggestions?
The following are some additional tips:
- Ensure you have two environments – test and production. Build your initial implementation and future department rollouts all in the test environment prior to any work in production.
- Make careful note of system settings/choices made in the test environment. Prior to go-live, all of those system settings will need to be set up manually in the production environment. Some solutions do not have the ability to copy system settings from test to production.
- If your organization sees both in/outpatients, some solutions can only default charge header data (from either the inpatient or clinic system) for one visit type, not both. It may make sense to default charge header data for inpatients since it is a multi-day stay so the physician will not have to enter the same data day after day.
- Plan your departmental rollout(s) ahead of time. Meet with departmental leaders at least two to three months prior to getting them scheduled. Pass out end user documentation to get the process moving.
- Be sure to capture any departmental “special” workflows that will need to be wrapped into the standard test plans developed for the ongoing rollout. You’ll want to review these with your vendor to ensure that the standard system can accommodate the departmental circumstance(s).
In Conclusion
These are just a few items to keep in mind as you get closer to your implementation start date. Upfront planning, as with all projects, is a key tenet of the implementation process. Especially for those of you with multiple large physician groups, planning will help you keep on top of what can be a long project, and ease the transition for users.
About the Author
Mike Tagliento is a senior consultant with Hayes, and has more than thirteen years of healthcare experience. He has extensive project management experience with an emphasis on software upgrades, design and implementation of enterprise financial systems.
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