CareBridge and E/Point: Integrated Charge Capture and Medical Necessity Documentation

Achieve optimal ED and hospital financial performance
 

The Picis LYNX CareBridge^® software application supports appropriate documentation of medical admission, observation services, medical necessity and physician intent by significantly improving the capture of detailed admission diagnoses, comprehensive medical risk factors, objective clinical data, ‘present on admission’ conditions, patient safety factors and physician plan of care.

Picis ED PulseCheck^® captures the data detailed above as a routine part of the ED PulseCheck workflow.

Fully integrated into ED PulseCheck, CareBridge in turn automatically provides ED PulseCheck with disposition scoring, feedback to clinicians as to whether their charting supports their disposition decision, and appropriate summary documentation – all without increasing the documentation workload on the clinician!

The result is validation that adequate medical necessity documentation exists to support the disposition decision. This provides the hospital with the necessary backup for more accurate reimbursement, compliance, and overall revenue management. Significant increases in hospital revenue are possible as well as minimized compliance risks from audits.

It is estimated that hospitals using CareBridge will realize millions of dollars in additional revenue annually for patients who stay in the hospital either as a full admission or as an observation patient from the ED.

An ongoing challenge for an ED is obtaining appropriate reimbursement for infusions and injections.

The Picis LYNX E/Point software application, which is integrated into ED PulseCheck, closes the gap between what could be billed and what is billed for facility visit levels, and procedure capture – including infusions and injections.

Combined with ED PulseCheck InSight ED^® rules framework which contains rules that help to improve documentation for charge capture and reimbursement, ED PulseCheck and LYNX E/Point close the loop for compliant and maximized charge capture through improved documentation. ED PulseCheck sends the documentation to E/Point for use in its charge calculation. The E & M calculator uses a sophisticated and long accepted algorithm to calculate the facility visit level based on documentation. E/Point has an equally sophisticated infusion/injection calculator to assign the appropriate current procedural terminology (CPT) code. The calculation results are sent back to ED PulseCheck, displayed on the E/Point Calculator within ED PulseCheck, and posted to the Chart Coding page.

The financial benefit of properly capturing the facility visit level and the infusion and injection charges averages $40 additional per ED visit, typically equating to millions of dollars of additional revenue annually for a hospital for the patients that are discharged from the ED.

The result – maximized reimbursement for ALL emergency department patients, whether they stay in the hospital or are discharged.