1. Acknowledgments
We thank the respiratory care staff of Metroplex
Health System for their assistance and ongoing
improvement efforts.
Introduction
With the introduction of a new leader in an acute
care hospital respiratory department, substantial
documentation errors and omissions facilitated the
need for immediate action. The urgent introduction
of a change management imperative yielded a 20%
increase in gross revenue and a 61% decrease in
charge capture errors in the first quarter following
implementation.
The new director reasoned the primary causes of
these errors centered on process variance,
inconsistency in communication, unnecessary rules,
and a lack of accountability. Given the demand for
demonstrating value-added productivity; this
department had to adapt through a rapid change
management practice design.
Methods
In tandem with the revenue cycle department,
backend edit rules for charge corrections were
applied. A standardized process for the staff
documentation workflow was put into place. Staff
was educated on documentation processes
workflow. Charge capture for this department is a
built in component of electronic chart
documentation.
Ongoing manual documentation audits had been
conducted to determine errors in charting including
the charge capture component. Notices were
distributed to the staff member with an error for
correction. Documentation errors were compiled and
reported each month including total charge errors by
dollar amount.
The audit process remained unchanged; however, an
accountability process was put into place to track
individual trends. Documentation errors were
compiled to determine charge omissions found in
chart audits and gross revenue data was pulled
directly from the cost center financial report.
Results
With the changes that were made to our
documentation process, we observed the following
results in the first quarter (Q1-16) of
implementation:
Compared to previous quarter (Q4-15):
• 20% increase in gross revenue
• 61% reduction in documentation errors
Compared to same period previous year (Q1-15):
• 20% increase in gross revenue
• 65% reduction in documentation errors
Conclusions
The introduction of a change management imperative can enhance the documentation
culture of a department and produce improved accuracy in EMR charting and ensure
appropriate billing, accurate volume and productivity reporting.
Transformation of a documentation culture increased gross revenue while
reducing errors
Amanda M. Richter, MHA, RRT-NPS, ACCS, RPFT¹; Nia George, MA, RRT¹; David Wheeler, M.Ed. RRT-NPS²
¹Cardiopulmonary Services, Metroplex Health System, Killeen, TX; ²Respiratory Care, Medical University of SC, Charleston, SC
Figure 1: Gross revenue per quarter compared to missed documentation charges per quarter
Figure 2. Trend comparison of charge errors to revenue which related to documentation errors and drives department productivity measures
Table 1. Documentation Errors (Missed Charge Amounts)
Quarter Amount ($)
Q1-15 97,821.14
Q2-15 84,657.11
Q3-15 105,753.58
Q4-15
Q1-16
88,601.71
34,622.27
Disclosures
None
Table 2. Gross Revenue
Quarter Gross Revenue ($)
Q1-15 2,470,538
Q2-15 2,419,013
Q3-15 2,280,323
Q4-15
Q1-16
2,467,535
2,959,583
Ongoing Efforts
We continue to audit charting and monitor
documentation errors on a regular basis. Metrics
are now broken down by individual, trends are
evaluated, and metrics are used for performance
evaluations.