Vanderbilt University Medical Center (VUMC), one of the nation’s premier academic medical institutions, is a comprehensive healthcare facility dedicated to patient care, research, and biomedical education. With more than 60 locations throughout Tennessee and Kentucky, VUMC’s 2,300 clinical provider physicians see more than 2 million patients each year.

As in many hospitals, in 2013, VUMC found itself reliant on many paper-based, manual processes for charging outpatient facility encounters. The organization needed to drive down late and missing charges while preparing to transition manual workflows, including paper charge tickets and back office data entry, to an automated process to prepare for the looming ICD-10 deadline. After determining that its homegrown outpatient order management system would not be appropriate, VUMC engaged MedAptus to implement Tech Charge Capture to ease the outpatient procedure documentation process across care teams and promote coding compliance and expedited payment.

An internal cross-functional project team, led by VUMC’s HealthIT Revenue Cycle Group, was formed with members from the ICD-10, coding, QA, and finance teams to collaborate with MedAptus implementation managers. While Tech offered functionality to meet the charge capture needs of VUMC across various outpatient departments, each with its own unique workflow, the group soon realized it would face challenges around how to create the ‘charge opportunity’ for each patient encounter given the number of disparate systems in place. As the team considered options to solve these challenges both creatively and efficiently, the core MedAptus interfaces were built: an inbound, HL7 interface from Epic’s Cadence system to bring in base appointment data, and an outbound interface, also HL7, for the export of ‘clean,’ approved charges to the VUMC billing system, Medipac (McKesson’s HealthQuest solution).

Pediatric cardiology was identified as the first area to pilot the Tech solution because it had a high volume of procedures that required multiple charge opportunities on a single visit. This area relied heavily on a patient encounter form that changed hands often and created almost 6 days of charge lag while the paper traveled from the clinic to the Charge Integrity area for entry into a key-entry system, Viking, and then made its way to Medipac for billing. VUMC was concerned that charges could be lost given the multiple hand-offs.

The objective for this pilot was to eliminate extra steps in the manual process, achieve a better charge capture rate and shorten the time-to-bill. Tech enabled electronic access to charge opportunities for pediatric cardiology charge capture staff based on Epic Cadence patient check-ins. It also expedited encounter documentation with easy shortcuts to the most commonly used pediatric cardiology CPT and ICD-9 codes. Shortcuts built in Tech mapped the appropriate ICD-9 code to a list of ICD-10 codes so that staff could choose the accurate 10 code for charging. The system then back-mapped the ICD-10 to the originating ICD-9.

With the software live, VUMC saw a significant reduction in charge lag. On average, EKGs were billed only 2 days after the patient encounter, decreasing charge lag by over 50%. In addition, MedAptus accommodated unique appointment situations where multiple services were registered under a single visit. By replicating this logic, Tech made it possible to reconcile against all expected charges as separate events (i.e., one appointment with both an EKG and holter device could be reconciled for two CPT codes ensuring revenue capture for both procedures).

Shortly after the pediatric cardiology area went live with Tech, the solution was rolled out to help with the capture of post-procedural observation charges; VUMC has 53 such units and documenting those kinds of charges was very complex. Prior to the piloting of MedAptus in this area, staff members ran McKesson Patient Management system reports to see which patients might need to be charged and reviewed documentation in the VUMC Star Panel EHR to determine if there was a technical charge opportunity present. MedAptus built custom logic in partnership with VUMC HealthIT to create charge opportunities for downstream reconciliation. MedAptus’ online, transparent encounter coding solution helped reduce charge lag in two days by making it simple to identify patients requiring billing.