Absence of a Signal should never be used as a signal

By: Chris Lanaman, Director, Professional Services


As Julian Bigelow, one of the engineers of the very first digital computer, once said, “Absence of a signal should never be used as a signal.”



This same theory is true of your Cerner® Millennium™ system. In the accounting world, all values assigned to assets or liabilities are real currency numbers. This means that these numbers can be negative numbers ($-3, $-2, $-1, etc.), positive numbers ($1, $2, $3, etc.) or zero ($0).


Strict adherence to having values for assets are called “Costs.” These “billable items” are vital in properly accounting for revenue and expenses. This means even the items or services that are given at “no cost” would have a value of $0.


Electronic billing systems use the same guidelines when populating billable items into the database tables.


The most important adherence is:

  • NULL Values are not zeros. These are unknown values (absence of a signal). This is a term which is used to represent unknown values or missing values. A NULL value in a table is a value in a field that appears to be blank.

  • A field with a NULL value in a table is a field with no value.

  • It is very important to understand that a NULL value (absence of a signal) is different than a zero value ($0).

Building an electronic billing system that does not account for all the bill items within its tables is an incomplete build that can cause loss of accountability of revenue.


When there are items within a hospital system that Centers for Medicare & Medicaid Services (CMS) will not pay the hospital for, such as bandages, these items need to have a charge value of $0 not NULL or not built.


Often there is a belief that you get the same results by not building these or giving them NULL values. This is a violation of accounting principles.


An excuse that is often used is, “That is a lot of work to build and maintain.”


Yes, it is. That is what true accounting systems are all about. You would not move into a house that only has the outside walls built. Neither should you accept a partially built accounting system.


Here are a few good practices to follow when building your accounting system for your EMR:

  1. Identify all the items you are currently charging for. Capture all the CDMs, CPTs and HCPCS when applicable.

  2. Complete the build for all the items that you do not charge for (must have a $0 charge built out). Capture all the CDMs, CPTs and HCPCS when applicable.

  3. Establish an audit system to capture any new items that have not been built out. I would recommend you do this at least monthly.

  4. Check and verify changing of CDMs, CPTs, HCPCS codes, as the regulations change.

  5. Limit or eliminate the need for manual charges. Your EMR is designed to automate your charging needs. Relying on people who know their charge codes puts your organization at high-risk due to turnover.


What does Softek Solutions, Inc. do?

Softek's mission is to help hospital systems get the most out of their investment in Cerner® Millennium™. We do this by providing innovative software solutions and consulting services that can achieve more together than either can alone.


At Softek, our team of innovators and software developers brings expertise beyond the ordinary to every client. Our experts are involved with Cerner® Millennium™ hospitals throughout the country consulting clients so they can optimize system performance and revenue integrity.


Softek delivers a full suite of consulting services and software solutions to assess and optimize EMR system performance, including revenue cycle integrity and patient accounting.


Let’s talk to see how you can get the most out of your Cerner® Millennium™ system.

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