Keeping track of the physical files at a medical practice, pharmacy, law office or accounting firm is a major responsibility. Aside from the sheer volume of paper, there are different types of forms, evaluations, prescriptions, briefs, tax information and other documents that make up the basis of operations. There are other issues as well.
Paper documents demand that people spend time coding, filing and retrieving, and they require space for storage. Time is money and space comes at a cost. Then there is the issue of making sure the information contained in those documents is accurate. This is where an enterprise document management program can come in handy.
“We had to do something,” said Tara Stawiarski, practice administrator at ChoiceCare Physicians in Pittsburgh. She’s been with the practice for 17 years and explained that the organization’s 10 physicians, six medical assistants and seven administrators specialize in physical medicine and rehabilitation of primarily disabled and elderly patients. It both generates and collects paperwork related to billing, estimation of benefits, charts for patients, lab work, insurance paperwork, prescriptions for hard equipment such as orthotics, home-care beds, wheelchairs, prosthetics and more.
Solving the paper issue
“We had a small room dedicated to filing, so everything was on paper,” Stawiarski said, explaining that the practice decided to implement an electronic document management (EDM) program. After two years of using a product that complicated the task of setting up files for a new patient and required “doctors to adapt to the program rather than the program adapt to what they wanted,” the practice tried CNG-SAFE from Madison, Al.-based Cabinet NG.
“We initially used it for storing all the explanation of benefits from all the different carriers,” Stawiarski said. Developers at Cabinet NG created a synchronization file to integrate the new product with a legacy practice management program that had been in use for a few years, automating the process of creating charts for new patients. The synchronizer runs in the background and updates a patient’s file every time a change is made on a chart or a document associated with that patient.
“It simplified the whole process,” Stawiarski said. Paper documents are scanned and attached to a patient’s electronic chart and routed to the appropriate physician’s inbox. All unstructured content, whether scanned images, Word or Excel files, PDFs, emails, photos, faxes and more can be imported, managed and merged with other files. Everything is stored in its native format in centralized repositories. CNG-SAFE manages all documents and automates workflow, saving time and keeping track of compliance issues.
Because all files at the practice are now electronic, ChoiceCare Physicians has eliminated rows of filing cabinets and ended the practice of sending things off to storage. As a result, Stawiarski said doctors decided to create “more space for seeing outpatients and made more space available for billable purposes instead of storage.” In addition, it has eliminated the practice of paying a monthly charge to an independent contractor for storing old patient charts and accounting files. “I can’t imagine having to go back to having paper and the chance of something getting lost.”
Stawiarski said the system also maintains accountability in the office and that a pending update to it will include an interface that enables direct transfer of lab results and a streamlined billing process.
Improved billing and coding
Billing issues led Tufts Medical Center in Boston to look into CNG-SAFE. It was having trouble finding qualified medical record coders to review medical records and code them correctly for billing services.
“We have a very high case mix of cardiology patients and transplant cases,” said Arnette Marbella, director of health information management at Tufts. She said it’s rare to find a coder who can handle the complexity of Tufts cases willing to commute to Boston, so the medical center regularly put the experts up in hotels, sometimes for up to a year or two at a time. That practice extended to four full-time equivalents. “You can imagine the cost,” Marbella said.
Tufts has been using CNG-SAFE since last year, strictly for coding purposes. Now, using a virtual private network connection that is for the express use of the billing department, four coders work remotely. The file-sharing system enables easy creation of folders and work queues for the staff and means records can be moved from one folder to another while maintaining an audit log.
“The difference is we no longer have to have a person on-site to review the paper chart. We use a PDF now,” said Michele Ciampolillo, the coding and operations manager at Tufts. “It provides the document, and we only use it for billing coding and inpatient coding.” The system also keeps track of electronic notes and communications between physicians, coders and nurses whether conversations take place over the phone or by email.
Complicated install at a price
“[CNG-SAFE] is not the most user-friendly thing to get installed” and it’s relatively expensive, said Sharon Conder, a certified public accountant for the Knoxville, Tenn.-based accounting firm of Pinkstaff, Simpson, Hall & Headrick,. But the promise of improved efficiency prompted the firm to explore EDM.
According to Cabinet NG, licenses for CNG-SAFE range from $495-$1,395 for organizations that want to store their documents in-house. Licenses for the CNG-ONLINE, a cloud deployment, start at $50 per user per month. Users that opt to store documents in-house can also purchase CNG-WEB web-based document management capabilities for a one-time fee of $1,500. CNG-WEB is available to CNG-ONLINE users at no additional cost.
Conder, who is in charge of the Sonic drive-in restaurant account at the firm, explained that she was responsible for the books for six Sonic franchises. A second full-time account reviewer and two full-time data entry clerks worked with her, and the team kept track of daily invoices, deposit slips, weekly earnings reports and transaction summaries. They had their hands full.
“Six locations was OK, but I knew that if we had more, we wouldn’t be able to handle it,” Conder said. Six franchises meant the account staff barely kept up with monthly filing reports. “It was difficult to keep track of the invoicing, and if something was misfiled, it was difficult to find the correct records.”
But those six accounts quickly expanded. “I knew a CNG reseller, and she suggested CNG might be a good resource. The biggest plus was that it integrated with QuickBooks,” she said. The firm purchased a CNG-SAFE license in 2008, and now when data is entered it posts to both QuickBooks and CNG-SAFE at the same time.
Conder and her team currently handle all the books for 26 Sonic locations in Tennessee and Kentucky. The system enabled the CPA to eliminate one of the full-time data-entry positions, cut twice weekly paper document shipping costs and respond to accounting abnormalities in almost real time rather than having to wait until the end of the month. It resulted in increased profitability for the accounting firm and a $40,000-a-year savings for the group of 26 Sonic franchises.
“I haven’t calculated the paper cost, but it’s huge,” Conder speculated, explaining that her firm has eliminated costs associated with renting a storage facility for paper records and now shreds incoming paper after it is scanned and recycles it. It also follows a firm-wide practice of not printing e-mails. Additional benefits are easily accessible records for company and state audits and a daily understanding of cash flow for franchise owners.
“They’re expensive; they’re not cheap,” Conder said, “but the money that we saved and the information that we have gathered so far more than paid for it.”
This was first published in November 2011