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HBOK 1-314

Title Reduction in the Percentage of Open Patient Encounters at the SMDC Clinic in Duluth, Minnesota
Author(s) Pam Helgeson-Britton
Source Healthcare Division
Topic Performance Improvement
Abstract In the ambulatory setting, clinic practice management is integrated with the electronic health record. Providers determine the codes and diagnoses for patient visits and are responsible for documenting care. When documentation is not entered in a timely manner, it affects timely billing and patient care. It is the action of completing and closing the patient encounter that causes the coding to post the charges for the visit. When an encounter is left open, no revenue is realized for that visit. As SMDC Health System implemented provider-based billing at the Duluth Clinic, it was even more imperative to force the timely release of the charges from closed encounters, as UB04 billing did not allow for line-item billing but required all charges to be posted before billing. Previous efforts to address this problem resulted in a one-time cleanup, but old practices resurfaced and the problem returned to former levels. No formal monitoring occurred and the focus was departmental versus system monitoring. A project team focused on the process of closing encounters.
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Reference Code 1-314

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