The Department of Anesthesiology and Pain Management at UT Southwestern Medical Center made about $45 million in revenue during the 2020 fiscal year. This money comes from usual anesthesia procedures and some complex services, showing the size of their work. A big part of making this money is the charge capture process for professional services. However, this process, especially for services at Parkland Hospital, is very slow and inefficient because it is done by hand.
The revenue cycle team has 18 coding and billing specialists. They are supported by two managers, a Revenue Cycle Manager, a Reimbursement Manager, and a Reimbursement Supervisor. This team puts charges into the Epic electronic health record (EHR) system. Even with these people, the department saw the time it takes to enter charges increase from 11 days to 23 days in 2020. Their goal was to keep it under 7 days. This delay can slow billing, delay payments from insurers, and can cause claim denials if data is missing or wrong.
Because this process is manual, coders and specialists have to enter thousands of charges each year—about 6,800 anesthesia charges in 2019 alone. Before the COVID-19 pandemic, charges outside of UT Southwestern were expected to grow by 9% every year. This growth means doing everything by hand is not going to work well for long. The work takes a lot of time and effort from the coding team. It increases risks and lowers how much work can be done overall.
Risks Associated with Manual Charge Entry
There are several risks linked to manually entering charges. These affect anesthesiology departments and the hospitals they serve:
- Increased Risk of Errors and Omissions:
Entering charge data by hand can lead to mistakes. These mistakes can be typos, missed charges, or wrong coding. This can cause billing to be wrong or incomplete. When this happens, it may delay payments, cause extra work, and lead to losing money if claims get denied.
- Lengthened Charge Entry Lag Time:
The rise from 11 to 23 days in charge entry time shows that manual work slows down the process. Slow charge entry lowers cash flow and makes it harder to plan finances each month or quarter. It also causes backlogs, which makes work harder for staff to handle.
- Impact on Revenue Cycle Efficiency:
Because there are many charges and anesthesia coding is complex, slow charge capture hurts the whole revenue cycle. When charges are late or incorrect, later steps like claims submission and payment posting also get slower or more difficult. This wastes resources and makes administration more expensive.
- Risk of Claim Denials:
If charges are missing or wrong, claims may be denied. This delays payment and means the team must fix and resubmit claims. This adds more work for the revenue cycle team.
- Provider Productivity and Compliance:
The department has a program to encourage providers to finish patient encounters quickly and keep records complete. But when charge capture is slow and manual, it makes these goals harder for everyone.
Recommendations to Improve Charge Capture in Anesthesiology
According to a report from UT Southwestern, there are a few ways to make the charge capture process better, especially at places like Parkland Hospital.
- Automation of Charge Capture:
One key idea is to automate moving detailed service data from Parkland’s Epic system into UT Southwestern’s Epic system. Automation can cut down on manual input, reduce errors, and speed up sending charges. Working with the Information Resources team will be important to make this happen with clear goals and teamwork.
- Enhanced Monitoring and Reporting Tools:
Better monitoring and performance tracking dashboards can help the revenue cycle team find errors and slow points faster. This kind of data check goes well with automation work.
- Training and Provider Engagement:
Regular training helps providers document their services right and finish patient records quickly. This makes sure charge data is complete and ready.
- Incentivizing Timely Charge Processing:
The current program rewards providers who stick to timelines and document well. Adding rewards for coders and billing staff could also help.
- Risk-based Prioritization:
The audit says the risk in charge capture is medium risk because the work is complex and slow, especially at Parkland. Fixing big and medium risks quickly helps keep the revenue cycle smooth and protects money goals.
Technology and Workflow Innovation in Charge Capture
Applying AI and Automation to Streamline Anesthesiology Billing
Using artificial intelligence (AI) and automation is becoming a useful way to solve charge capture problems in healthcare. These tools can change hard, slow processes into faster and more accurate ones.
- AI-Enabled Data Extraction and Processing:
AI can be taught to look at clinical notes, find services to charge for, and suggest billing codes. This lowers the need for manual review and cuts down errors. In anesthesiology, where coding is hard because of many procedures, AI can help accuracy a lot.
- Intelligent Workflow Automation:
Automation can handle regular tasks like moving data between different EHR systems, matching charges, and finding errors. Automating these steps can lower lag times and improve billing speed. For example, automating charge capture between Parkland and UT Southwestern’s Epic systems can fix current gaps.
- Continuous Learning and Adaptation:
AI systems learn from past billing data and adjust to updated coding rules. They can catch missing or wrong charges early so problems get fixed before claims are sent.
- Resource Optimization:
By automating repeat tasks, the revenue cycle team can spend more time on valuable work like checking audits, handling denials, and talking with providers. This helps staff use time better and lowers burnout.
- Enhanced Data Analytics:
AI-based analytics can show detailed patterns in charge capture, common errors, and places to improve. This helps managers make better decisions and target fixes.
Specific Considerations for U.S. Medical Practices
For large U.S. medical centers like UT Southwestern, managing anesthesiology billing needs attention to these main points:
- Regulatory Compliance:
Charge capture must follow rules from Centers for Medicare & Medicaid Services (CMS), local insurers, and HIPAA laws. AI tools must include these rules to avoid legal problems.
- Interoperability Between Systems:
Hospitals often use more than one EHR system. The problem is making sure data moves smoothly between different systems and charge capture stays consistent.
- Volume and Velocity of Charges:
Anesthesia departments in the U.S. handle thousands of charges each month. Doing all this by hand is not practical. Automation is needed to keep up.
- Financial Impact:
Delays and errors in billing can hurt hospital revenue and budgets. Hospitals and clinics need to focus on fast, accurate charge capture to keep money healthy.
- Provider and Staff Training:
Because rules and technology keep changing, ongoing education is important to keep charge documents accurate and timely.
Final Notes on Addressing Charge Capture Challenges
The UT Southwestern Anesthesiology Department’s experience shows common problems faced by anesthesia billing in the U.S. Manual methods can work if staff are dedicated and there are rewards, but growing charge volume and complexity add risk for delayed payments and mistakes. The audit points to the need for teamwork between clinical staff, revenue cycle teams, and IT to bring in automation, improve checks, and increase training.
Using AI and automation can cut down on the work load for coding specialists and make the process more reliable. Centers that use these tools are more likely to meet goals, avoid money penalties, and give steady patient care without billing delays.
For hospital managers, practice owners, and IT leaders in the U.S., knowing these issues and acting early is important. As healthcare changes, using technology-driven processes will play a bigger role in keeping anesthesia billing steady and effective.
Frequently Asked Questions
What is the revenue generated by the Anesthesiology Department at UT Southwestern?
In fiscal year 2020, the Anesthesiology Department generated approximately $45 million in revenue, which included income from unique and complex anesthesia procedures as well as support service agreements.
What are the key components of the Anesthesiology Department’s Revenue Cycle team?
The Revenue Cycle team consists of two managers, a Revenue Cycle Manager, a Reimbursement Manager, a Reimbursement Supervisor, and 18 coding/billing specialists responsible for charge documentation and entry.
What is the main objective of the Revenue Cycle Charge Capture audit?
The main objective was to assess the effectiveness and efficiency of operational processes and internal controls related to charge entry, documentation, and reconciliation.
What were the major findings regarding charge capture processes?
The audit identified that the manual charge capture process for services at Parkland was labor-intensive, increasing the risk of errors and billing delays, with a notable increase in charge entry lag time.
What is the recommended solution to improve the charge capture process?
The recommendation includes coordinating with the Information Resources team to automate the export of detailed information from the Parkland Epic system to the UT Southwestern Epic system.
What are the risks associated with the current manual charge entry process?
The manual process increases the risk of missed charges, billing delays, and could lead to denials if incorrect or incomplete information is entered into the system.
What training does the Revenue Cycle team provide to new providers?
The team provides onboarding training on appropriate charge documentation and the requirements for timely patient visit encounters.
What incentive program has the Anesthesiology Department established?
The department has established a provider incentive program to ensure timely closing of patient encounters and completeness of medical record documentation.
What performance metrics are monitored by the Revenue Cycle team?
The team monitors operational metrics such as timely and complete charge entry, charge documentation accuracy, and ongoing reporting of performance metrics.
How does the audit report classify risks and define action priorities?
The report classifies risks as High, Medium, or Low, based on their potential impact on achieving strategic or operational objectives, with urgent actions required for High risks.
