Healthcare billing departments are dependent on getting accurate information in a timely manner to meet its goals: increasing cash flow and decreasing operational costs.
The challenge is getting the data from multiple systems and even multiple facilities. Many manual methods such as faxing, printing, scanning, etc. are used to facilitate the information gathering. Getting the needed patient demographics and charge capture data can be accomplished using HL7 interfaces* or through HL7 integration initiatives.
(*Note that interfaces are dependent on an application’s ability to speak HL7, or produce or consume data in an electronic format.)
HL7 integration presents the opportunity to streamline processes and share information quickly between systems. For example, in a hospital setting, if the laboratory adds on an additional test (e.g., reflex test), then the lab can send a charge message directly to the billing department. The billing department will get notification of the add-on procedure, and it will not require any manual intervention by a clinician to fill out a manual charge capture form.
Among the hundreds of messages in HL7, the four most common messages used to transmit information to a billing department are the following:
- DFT = Detailed Financial Transaction
- ADT = Admission, Discharge, Transfer
- ORU = Observation Result Unsolicited
- BAR = Billing Account Record
Outlined below is an example DFT^P03 message:
PID|||1234567||JONES^JOHN^^^MR||19270523|M|||1 MAIN AVENUE^^PLANO^TX^75093^||214/555-5555~~|~~||M|||123-12-1234||
GT1|1||JONES^JOHN^||1 MAIN AVENUE^^PLANO^TX^75093|214/555-5555||19270523|||Self|123-12-1234||||^^^^||||
IN1|1|5||MEDICARE-FIRST COAST|Po Box 44234^^Jacksonville^FL^32232||203/639-3124|||||20041214||AUT1234567||
JONES^JOHN^|Self|19270523|1 MAIN AVENUE^^PLANO^TX^75013^|||1|0|||||||||||||123121234A||||||||^^^^|
IN1|2|11||ANTHEM BLUE CROSS AND BLUE SHIELD|P.O. BOX 533^^NORTH HAVEN^CT^06473||1/800/922/3242|||||20041214||||JONES^JOHN^|Self|19270523|1 MAIN AVENUE^^PLANO^TX^75093^|||2|0|||||||||||||XGM0555M50555||||||||^^^^|
Automating your environment with HL7 interfaces leads to many tangible and intangible benefits for your billing facility:
- Increased accuracy with reduced manual entry
- Increased Turn Around Time (TAT) with data flowing to billing in near real time
- Decreased paper records storage and office space with electronic data (digital archive)
- Fewer denied claims due to timely and complete information
- Increased cash flow with lower DSO (Days Sales Outstanding)
- Improved data retrieval – faster, searchable, simultaneous access by multiple users
- Increased patient satisfaction with more accurate billing
- Increased efficiency
The end result of implementing HL7 interfaces to automate the collection of accurate, timely clinical data for your billing workflow: Your operations will be more competitive, profitable, and streamlined.
Review the recorded webinar presented on this topic July 31, 2007.