Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Are You Billing for Every Patient in the Emergency Department?


How a Chart Reconciliation Process Can Help

Let’s face it, the emergency department can be a little chaotic, especially during shift changes and high volumes periods. In the past, paper medical charts might have sat longer on a desk than they should have or never gotten signed at all. With EMRs, a flagged record might still sit in someone’s inbox or remain uncompleted, particularly if the patient is admitted or leaves against medical advice. Or results from pathology or radiation might leave a patient—and her chart—in limbo. And these are just the predictable problems with the standard flow of a medical record and its ultimate arrival at the billing office.

Things happen.

But when something unusual happens to a prevent a patient’s chart from properly proceeding through the revenue cycle, it means a missed opportunity to bill the patient or her insurance for the services provided. Missed opportunities result in missed revenue.

So what should you do to be certain that you are billing for every patient in the emergency department?

Set up a chart reconciliation process with your billing department or billing company. It may take a little thought and work in the beginning, but in the long-run, you can ensure you are not missing revenue by missing out on billing opportunities.

While the specifics of a chart reconciliation process will vary depending on your practice management system, here are few key things to keep in mind:

  1. You will need a copy of the emergency department log, preferably in electronic format, so that you will know how many and which patients you are expecting to bill for each date of service.
  2. You will need to account for any patients who are listed on the ED log who will not be billed for your services for any reason. For example, if you do not bill for patients who leave against medical advice or for patients who register in the ED in order to see an outpatient specialist, you need to be certain you aren’t counting those as missing when they really are “no bill.”
  3. Depending on how you count encounters or patients in your billing system, you will need to allow for patients who were seen twice in one day or who have a “split visit” and were seen by more than one provider. These exceptions could skew your comparisons.
  4. You will want to wait a reasonable amount of time before comparing your entered and expected patients to allow for late charts that will naturally arrive at your billing company without intervention.
  5. For the dates of service when the number of patients billed doesn’t match the number of patients on the ED log, you will need to determine a quick way to compare a list of patient names for each to determine who is missing. (This is why it is helpful to get the ED log in electronic format.)
  6. Recognize that some discrepancies in the chart reconciliation process result from billing mistakes rather than missing charts. Determine how you will resolve these issues when they are discovered.
  7. Once you have identified the patients who have not yet been billed, track down their charts through the hospital EMR or medical record department so they can be billed.
  8. Determine your tolerance for missing charts. Are you comfortable with one percent of charges never being entered? Or do you want every chart accounted for no matter how much effort is involved?

Developing a chart reconciliation process will help you ensure that all of your patients are billed in a timely manner, maximizing your own revenue and preventing untimely or inaccurate bills from reaching payers and patients. Have more questions? Contact CIPROMS for help. Chart reconciliation is a standard part of our emergency medicine coding and billing process.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com. Photo by Lydia via Flickr used with permission under the Creative Commons License.


Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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