Dedham Medical Associates
Dedham, MA
In the late 1990s, Dedham Medical Associates (DMA), a physician-owned multi-specialty practice located in eastern Massachusetts, started to analyze a transition to the electronic medical record (EMR). Unexpectedly, this analysis of the leap from paper medical charts to an EMR uncovered a significant business issue at DMA: not only was the practice's paper-based charge capture process creating a serious lag time between charge capture and actual submission for payment, but once charges were in fact submitted, a high volume were ultimately denied due to coding inaccuracies.
According to data from the Centers for Medicare & Medicaid Services (CMS), DMA's experience was not atypical: practicing physicians frequently lose upwards of $25 billion per year in denied or reduced claims, which equals an annual loss of almost $60,000 per year for each of the 450,000 practicing physicians in the US.
"By implementing an automated alternative to the traditionally cumbersome manual capture of charges for ambulatory services, we were able to reduce our billing process from almost 20 steps, to less than five."
Electing to put an enterprise EMR on hold, the practice set its sights on identifying and implementing an easy to use and "intelligent" charge capture solution. In December of 2002, after completing a six-month vendor review and comparison, DMA contracted with locally based MedAptus. DMA believed that the modular design of the MedAptus application suite would allow for incremental implementation, minimizing clinical disruption and ensuring maximum clinician adoption.
The first group of Professional Intelligent Charge Capture users at DMA was comprised of 28 providers from the pediatrics and internal medicine specialties. Within six months of signing with MedAptus, DMA experienced a six-percent increase in gross charges per encounter, largely due to an eight-percent improvement in the capture of procedure codes. Further, an expedited billing process, in combination with more accurate coding, led to a per-physician financial benefit of more than $20,000 in just one-year of MedAptus use.
DMA's decision to deploy the MedAptus solution, ultimately to its entire physician base, saved the practice administrative time and resources, while simultaneously increasing reimbursement. Overall, DMA expects to have enhanced their bottom line by more than half-a-million dollars.
In 2007, DMA started to use MedAptus in an integrated fashion with the EpicCare® EMR system from Epic Systems Corporation. The integration allows physicians to document the patient encounter, including procedure and diagnosis codes, once. A real-time interface then transmits charge data from Epic to the MedAptus RCA Engine, where over one million coding and compliance rules are applied, assessing the charge for appropriateness. Any charges with coding violations are held for review, reducing potential denials and revenue loss.