CoxHealth

The system offers a comprehensive array of primary and specialty care through six hospitals and more than 80 clinics including the large Ferrell-Duncan Clinic, a wholly-owned subsidiary of CoxHealth with 140 physicians practicing in more than 20 specialties and sub-specialties.

Disparate Systems Create Overhead

Like most healthcare organizations, CoxHealth is continuously seeking to optimize and leverage its existing – and disparate – health information technology investments. When it came to visit coding and billing, the clinic used a Cerner EHR system while the business office relied on an IDX billing system from Athenahealth (formerly GE Healthcare). Challenges with the two systems communicating created a manual back-office workflow that involved printing paper superbills for subsequent data entry into IDX. This not only added built-in time and overhead to the billing process, but it also led to high reliance on paper and costs to print, manage, and store.

Preserving Provider Workflow

Despite best intentions and advancingEHR technology, it can still be challenging to eliminate paper and manual handoffs from medical billing. This led CoxHealth to originally approach medaptus about how to enable a more efficient billing process given the disparate systems at the front and backends of its process. After reviewing medaptus’ platform and capabilities for re-engineering revenue cycle operations with logic and automation, CoxHealth engaged with medaptus for software to automatically review, queue, and hold charges generated in its Cerner EHR system prior to insurance billing.

Given physician comfort using Cerner to document charge data, CoxHealth was relieved to learn that medaptus can be installed with no impact to physician workflow. The software can be configured to accept what the physician has already documented in the EHR. Today Cerner transmits coded encounters to medaptus where an embedded compliance engine runs configured rules on the encounter to evaluate appropriateness. And with 100 departments and clinics using medaptus, the ability to configure and flag rules for what best suits the need is important. As an example, CoxHealth has a number of rural health clinics with stringent billing rules for payment depending on the visit type.

Looking at Results

Another educational opportunity at CoxHealth following the 9-month implementation of medaptus was with providers. Habits that had been developed over years with coding and billing that led to errors were previously(and manually) removed by business office staff prior to data entry. This revealed to CoxHealth that they could engage providers to help tighten up or refine their coding decision-making process.

Throughout this all, quantifiable gains were recorded. Prior to medaptus, there was an allowed two-day grace period between the visit and printing the superbill to work. This process has been eliminated and has helped reduce system-wide charge lag at least 3-4 days, more in some areas. In fact, some clinics are billing same day of service.