Missing Charts cause payment delays and a direct loss to the Practice when they cannot be located for entry into the billing system. EGO invests significant resources into the chart control system for both electronic and paper-based transfer of records.

Electronic Transfer

An interface with the hospital's registration system facilitates indexing of scanned charts or dictation downloads. EGO expects to be able to implement an electronic chart capture system, using the Hospital's existing records or implementing a scanning system onsite at each hospital location.

EGO would like to receive a daily demographic download of the registration data from each hospital on each business day with charts from 3 or 4 days prior to the download date. This is to allow time for the hospital to verify the accuracy of the demographic information captured at emergency registration and assures that the Practice is provided with the most accurate billing data possible. Transfer is accomplished through EGO's own secured FTP site, assuring adequate internet security.

Transfer of physician service information is commonly done through dictation downloads from the transcription company directly into EGO's databases. For those sites where the Practice does not dictate, copies of the physician template and related documents, such as the physician order sheet, triage record, nursing notes, etc. can be captured from the hospital's electronic medical record or imaging system. If the emergency record is paper-based, and the hospital does not use scanning technology to capture these medical records, EGO can implement a scanning system onsite at the hospital that indexes each chart to the patient's demographic information. A match is performed with the patient log system and missing charts flagged for later retrieval when the chart package is available in the system.

Paper Transfer

For paper-based clients, EGO has an arrangement with a local courier service to have billing packets picked up daily at each Practice location, without charge to the Practice.

For paper-based Practice sites, EGO will work with the client's onsite chart coordinator who prepares daily batches of billing packets and locates missing information through the following process:

1. The Liaison assembles billing packets including copies of the physician's chart, registration data, insurance cards, etc. and determines that all of the information we need to bill is legible and complete. If information is incomplete or missing, she/he will try to obtain the information needed from the hospital staff, the emergency physicians, or other sources.
2. Billing packets are then compared to both the Emergency Department registration log and emergency physician inpatient service log. This is done to verify that a billing packet was prepared for every patient listed on the logs.
3. Charts received in EGO's office with incomplete or missing physician documentation are returned to the physician for correction or amendment. These incomplete medical records are then tracked to make certain they appear in the billing process.
4. Assembled billing packages are sent to Emergency Groups' Office daily via a local courier service.

   1. Hospitalist Billing

      Some clients have been asked by hospital administration to form a hospitalist service and to assume the billing of their hospitalist physicians. We perform those billing functions. For others, we contract directly with the Hospitalist(s) for our services. The results of these separate agreements have far exceeded expectations.

   2. Hospital Facility Coding

      Under Medicare Outpatient Prospective Payment, hospitals are struggling to adapt to the new coding system that determines their emergency department revenue. The coding system is based on CPT but has many confusing variations that leave hospital coders often unable to accurately capture all the revenue due the hospital. Numerous studies have documented hospital losses of between $25 and $90 per patient due to the inability to properly classify facility levels and report payable services. Using specialized expertise gained from years of studying the new outpatient payment system, EGO now provides a means by which the Hospital can improve its compliance and revenue at the same time. When we code from a copy of the pertinent ED medical record, we can code for the services provided by both the physician and The Hospital.

When the billing packets are received in our office, they are again compared to the logs for each date of service. While this duplicates work done onsite, it is a necessary audit of the checks performed by our onsite liaison clerks and of the courier service. Shortage lists are monitored over time with reports to the Practice when missing charts cannot be located. We will account for every patient listed on the logs.