Updated: Oct 12, 2018
by Jesse Hodes
The word inconsistent is generally used with negative connotation. In fact, some synonyms for inconsistent are: uncertain, unpredictable, and unreliable. When it comes to your hospital’s EHR, adjectives such as these are not something you want it to be associated with - especially when dealing with charging. What if I told you that nearly every Cerner client we have ever worked with has inconsistent charging occurring within their environment? What if I told you that sometimes these missed charges are leading to millions of dollars in lost revenue?
A few years back, our team at Softek was working with a client and pulling some information on their charge activity. After looking into the data, we noticed typical activity such as orders generating charges and orderables going through the system without generating charges. As we dug deeper, we started seeing some things a little more atypical. What we noticed were that at times there were orderables that sometimes posted charges, yet sometimes didn’t. We knew HOW this could happen, but what was the intention of the client? Were they trying to charge for these orders, or were they not?
What we saw would have shocked us if we hadn’t known the complexities of the charge tier build, pricing tools, and other build applications that drive charging within Cerner. For clients new to Cerner it is a fair assumption that “either you charge for something, or you don’t”, while in the Cerner world you may see things like this:
As you can see above for the orderable: XR Chest 1 View, the orderable was ordered 546 times over the selected timeframe. 525 times it went thru the system and wrote a charge to the charge table just fine. Seven times, however, it wrote nothing at all- meaning that no charge would have been posted via the interface.
So what are the causes of these inconsistencies?
In our experience, the most common root causes are the following:
1. Location issues:
a. One or more Pyxis/Omnicell machines not set up to generate charging
b. A new facility, nursing unit, etc. added to the environment yet not set up to charge
2. Registration issues: Picking an incorrect Encounter Type that does not generate charging
3. Charge point issues: Workflow causes orderable to “skip” charge point
Could any of these issues be happening at your organization?