As patients enter the busy emergency department of their local hospital, it’s likely that some of them might provide fictitious demographic or insurance information about themselves. This deception—as well as other inconsistencies in the billing process—puts the emergency medicine practice at risk of losing revenue for the encounter.

All emergency practices want to be paid promptly—and properly—for the services they provide, but they need clean data to receive the revenue they earn by providing care. There are several ways emergency medicine practices can simplify the process of getting paid—and paid quickly.

Prompt and Proper Data Transfers

Emergency practices typically receive ADT demographic data from hospitals via an HL7 message. They then pass the information to insurance-verification partners such as Payor Logic or Emdeon to run up-front insurance checks.

In the case of LightSpeed, once a billable insurance payer is identified and the data are returned, the case is sent for coding. Correct CPT, E&M and ICD-10 codes combined with accurate insurance information are uploaded to the practice management system to drive quick and accurate billing processes.

A new LightSpeed workflow, electronic validation, adds a subsequent layer of automation that removes many of the manual steps known to slow down emergency medicine billing.

Electronic Validation to Segment Accounts, Flag Cases

Electronic validation segments accounts by diagnosis and matches patient age, insurance coverage or payer, CPT or ICD-10 codes, and other variables to flag cases for specific workflows. One example is flagging cases that require quality measure reporting.

If the case is a match, ICD-10 and CPT codes prompt coders throughout the process of recording the appropriate quality measure documentation from the chart.

  1. The software triggers a layer of validation to inform the coder that quality measure documentation must also be reviewed
  2. The coder enters the documentation, data and correct codes
  3. Reporting and tracking validate all measures are met for PQRS and MIPS with gap and exception reports

Electronic validation workflows ensure all steps are completed accurately and thoroughly, so fewer cases are rejected on the back end, and all appropriate cases are included for quality measure reporting. The electronic validation process saves time, and dashboards display reports in real time for management oversight.

Boosting Coder Productivity in Practice

According to a large, multi-location specialty medical group that uses LightSpeed’s technology, the systemsuccessfully reduced its cost to code by achieving a 300 percent increase in coder productivity. Their coders no longer spend time tracking down information, identifying documentation gaps or communicating with physicians. LightSpeed handles these tasks for them. Changes introduced by LightSpeed saved coder hours and administrative paperwork hassles for this organization, driving to drive significant operational savings and workflow improvements.

To learn more about LightSpeed’s coding workflow and electronic validation capabilities, check out our solutions here.

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