I am currently working with Clark & Daughtrey Medical Group to solve a unique problem. The group, which boasts national accreditation in many of its specialties, is looking to report on PCMH measures in innovative ways. So we started a conversation on how we could help them reach their PCMH goals. We discovered that their payers are reimbursing them for performing various clinical assessments. To do this, they have custom charge codes that are manually entered into the practice management system based on a medical coder’s review of each note. The medical billing staff spends hours every day sifting through these notes and entering the charges based on pre-configured flags in the note. With over 800 patient visits every day, this task is tedious and costs the practice a lot of money.

They asked us if there was a way that we could help them report on certain items in their notes. Unfortunately the note data is not discrete like medications and problems. It is actually a complex document stored in a format known as XML.While XML is a structured language, the document is first compressed then stored as one long string of text in the database. This means that if you wanted to search through the note in the database you would first have to decompress the note and then scan through the entire document for an identifier that is specific to that note. That is a nightmare for any type of reporting!

After talking with the staff at Clark & Daughtrey Medical Group we realized that this entire process could be automated! Using Note Form Reporting, I have developed a way to identify the appropriate check-boxes in the note and automatically submit the charges to the EHR. If the level of service charge has already been processed, then the charge is automatically submitted to the practice management system; if the encounter level charge has not been submitted then the provider will see it in the Allscripts Enterprise application just like any other charge waiting to be submitted. Clark & Daughtrey Medical Group will no longer have to waste time and money searching these notes for charges, the possibility of human error will be reduced, and the charges will now appear in both in the practice management system and the EHR.