Health Information Management: Advisory | Charge Capture Services

UAB Medicine

UAB Hospital is a major center for clinical research and the home of some of the top medical programs in America. Our faculty physicians, nursing staff, and support personnel are committed to providing world-class care to every patient.

The centerpiece of UAB’s clinical enterprise, UAB Hospital is located in Birmingham’s Medical District. In the midst of UAB’s major research centers and clinics, the 1,157-licensed-bed hospital is among the 20 largest and best equipped in the nation. We provide patients with a complete range of primary and specialty care services and the most up-to-date treatments and innovations in health care. Here you will receive tomorrow’s medicine today for both routine and complex diagnoses. As a major center for clinical research, you may be offered treatments at UAB Hospital that are unavailable elsewhere in the area.

The Challenge

University of Alabama BirminghamThe University of Alabama Birmingham Hospital (UAB) implemented Cerner’s Millennium Electronic Medical Record (EHR) and Cerner’s PowerChart nursing module - iVIEW, which enables clinical staff the ability to document concurrently as the patient moves between care settings; thus, fully supporting the continuum of care. While this module functioned well within the inpatient arena, it was not deemed an effective solution in the Emergency Medical Services (EMS) department. EMS nurses found the new documentation process difficult due to multiple data entry tasks and confusing workflow; creating a technology adoption challenge which resulted in fragmented documentation.

UAB nurse coders found these fragmented medical records difficult to read and understand, making the task of finding and verifying the necessary documentation impossible. The nurse coders were often unable to locate all necessary documentation for the services (e.g., tests, procedures, and IV therapies) provided to the patient and essential to completing the UAB Emergency Department Charge Ticket for determination of the Emergency Department (ED) charges in a timely and efficient manner.

Prior to the installation of Cerner Millennium, the UAB nurse coders completed an average of 300 charge tickets per day. To address this productivity shortfall, an additional full-time employee (FTE) was hired, and nurse coding staff hours were increased to include evenings and weekends in efforts to meet prior work standards. Despite these efforts, the backlog of EMS visits requiring charge tickets continued to grow.

The Collaborative Approach

A dual approach was used to address the fragmented documentation created by the new module and inefficient processes. First, the UAB Information Technology (IT) department would need to develop a hybrid version of the module for the EMS department enabling the EMS nurses to document a central line, time out and port access in iVIEW. All other EMS nursing documentation would continue being recorded on e-forms (the same document used prior to the installation).

Once the system modifications and process redesign work were completed, JTS began work against a back log of 10,000 open balance accounts, accounting for an estimated $75,000,000. JTS’s initial goal was to reduce the backlog to a reasonable industry standard of 5 days within 30 days.

JTS responsibilities:

  • Develop standardized and illustrative work instructions assuring that staff processed the account in a uniform and consistent manner thereby reducing the likeliness of denials or other forms of reimbursment delay
  • During the initial 30-day backlog reduction period, the JTS Charge Capture Team focused on the backlog allowing UAB to focus strictly on current accounts
  • Once the initial backlog was resolved, UAB engaged JTS’s Charge Capture Team to assist in maintaining the current workload. JTS resolved, an average of 5,600 accounts per month, with 3 FTEs

The Accomplishments

In summary, more than 87,000 claims were resolved throughout the multi-year engagement.

UAB Emergency Charge Capture Graphic