Making beautiful music together: a behavioral health hospital in Maine and an acute care IS vendor break new ground in IT

Health Management Technology, March, 2005 by Bonnie Thibault

Matrix billing. To bill in behavioral health, we must have the ability to track credentialing of all clinicians, not just physicians. Therefore, we needed to create a credentialing matrix that identified the sites where our clinicians work and the kinds of services they are authorized to provide at those individual sites. To provide services with appropriate coverage, we then connected that data to scheduling so alerts would flag us if insurance would or would not pay, and fed all the data into billing.

Since individual therapy involves one price for a visit with a clinical psychologist and another price to see a social worker, for example, we created a matrix billing system in which we entered one type of encounter into our chart of accounts and kept the complexities of the case off the chart of accounts to maintain the integrity of the latter. To make it even more complicated, behavioral health for the state of Maine currently requires Z codes (the equivalent of CPT codes) for billing, and payers may want all billing broken down into 15-minute increments, so we had to allow for that, too.

Medical records. Previously, medical documents would be printed in the medical records department, sorted, delivered into the physician's unit, and then the paper document was put into a chart. With an interface to our transcription service through MEDITECH's imaging and therapeutic services application, any medical document transcribed by our physicians is available from our system as a standardized format document, which physicians can edit electronically and sign online. By reducing a four-step process to two steps, we've reduced the turnaround time from transcription to sign-off from 72 hours or more to 24 hours or less.

Processes for Today and Tomorrow

This is just a sampling of our enhanced capabilities today. During implementation, we took the opportunity to step back and ask ourselves, "What do we want for tomorrow?" MEDITECH helped us to be very thoughtful about building the right processes for today and the future.

The amazing thing is that my team of four IT members and I built these systems with the vendor and our user community at the same time we were constructing our new $27 million hospital, which opened in the spring of 2004. At the same time that I was overseeing the wiring for the new hospital, we were implementing a new HIS--and it all went off without a hiccup.

Our efficiency has increased dramatically. Our system tracks denials management information, so we can see that our denial rate has gone from 65 percent down to 18 percent. Payroll is no longer a stand-alone system in which we enter the data twice. Now, payroll information is loaded automatically into the general ledger, saving us approximately 24 man-hours every month.

Because we have the materials management module installed, purchase orders are automatically fed to accounts payable for payment, which then feeds data to the general ledger. Our ability to generate reports has helped tremendously. We can now identify statistically what we thought was happening and improve processes based on this. Many processes that were manual are now automated--for example, the way that we track the status of involuntary patients. Now, at the push of a button, we can generate reports based on state regulations. We owe our improved efficiencies to our staff's dedication and to our new behavioral health information system.