Data Collection Workflows: Avoiding Inconsistent Visit Counts in the EMR and Billing

In this article, we tackle two common questions that occur when comparing your Analytics and Billing data. 

  1. Why do my visit counts in WebPT Analytics differ from those in Billing?
  2. Why do my visit counts differ between EMR reports?

Why do my visit counts in WebPT Analytics differ from those in Billing?

There are several reasons why your visit count in WebPT Billing may differ from the visit counts in the WebPT EMR and Analytics. 

  • NORCM: One common reason is the use of the NORCM code on the documented visits in the WebPT EMR. 
  • Inactivating Patients: Another reason may be that one or more patients have been marked as inactive in the WebPT EMR. Patients that have active charges cannot be marked inactive inside WebPT Billing. As a result, when a patient is marked as inactive and the patient has active charges, this will cause a discrepancy between the WebPT Billing and EMR reporting. 
  • Quick Add Patients: Patients added using the Quick Add functionality with incomplete profiles will be prevented from flowing into WebPT Billing. Additionally, therapists won't be able to finalize notes for those patients, so the patient and all related charges won’t be reflected in Billing until the patient’s record is complete.
  • Patients Created in Billing: Patient’s created directly in Billing for the purpose of adding charges manually will not flow into the WebPT EMR.
  • Charge Audit Summary: The Charge Audit Summary report counts interest and insurance overage charges generated in Billing as visits, which causes a discrepancy as these are not included in the EMR visit count.
  • Database Update Intervals: Analytics and WebPT Billing use two different databases, which update the data at different intervals. Analytics updates the data every two hours, while WebPT Billing updates the data near real-time. 

Note: If you are looking at data prior to May 2020, unprocessed addendums will also result in visit discrepancies. 

NORCM Impact on Analytics

The NORCM code is added to the patient note when the provider doesn’t want WebPT Billing to process the charges, a common example of this is for a self-pay service. This code allows the note to be finalized and work like any other finalized note within the EMR, however, the note will not flow into Billing. 

Important: If NORCM is entered incorrectly in the note, the visit will flow into Billing and charges will be billed, if associated with an insurance. 

Using the NORCM Custom CPT code does not impact WebPT EMR reporting. Visit counts in the EMR do include finalized notes with the NORCM custom CPT Code. While these NORCM notes are included in the EMR reporting, they are not processed through the billing integration and therefore not available in the Billing reports. Since the NORCM visits are counted in the EMR and not counted in Billing reporting, your visit counts won’t be the same between the two systems if using this code. 

To locate the number of visits where the NORCM code was used, follow these steps:

  1. In Analytics, open the Billed Units report. 
  2. Filter by the NORCM CPT Code.
  3. Click on the CPT Code header, select Aggregate, then Count
  4. The number that appears is the total number of notes(visits) where the NORCM code was used.

Inactivating Patients

Often, Members use the Inactive patient status, instead of the recommended Discharged status in the WebPT EMR to cleanup unwanted or unneeded patient information. However, because patients cannot be inactivated in Billing and WebPT Analytics does not include inactive patient data, there will be a disparity between the two systems in all financial reporting for patients marked as inactive that have charges or payments tied to their account. Click here to learn more about inactivating patients and the safeguards we’ve put in place to protect your data. 

Patients Created in Billing

If a billing user wants to manually enter charges for a patient that does not exist in Billing, they may create a new patient or create a dummy patient within the billing system. Patient records do not flow from Billing to the WebPT EMR and therefore these patients and charges will not be included in the EMR reporting but will appear in Billing.

Charge Audit Summary

When Members receive payments that are not associated with existing charges, interest and overage charge records are created for them and appear in the Charge Audit Summary report. 

The Charge Audit Summary report records these interest and insurance overage charges as visits. This causes a discrepancy between the EMR visits count and what is shown in the Charge Audit Summary report.

Database Update Intervals

Analytics and WebPT Billing use two different databases, which update the data at different intervals. Analytics Reports update every two hours, while WebPT Billing updates are near real-time. 

Clinics should keep in mind that depending on the time of day and how busy the clinic was, there could be large discrepancies between the two systems solely based on the intervals in which the two systems update data. We recommend running reconciliation reports up to the previous day.

Why do my visit counts differ between the various EMR reports?

Delays in Note Finalization

The most common reason why the Scheduled Visits report and note-based visit reporting (patient notes/notes by clinic) will not match is due to delays in note finalization. It is common for some providers to finalize patient notes 1 to 3 days after a scheduled encounter has occurred. Therefore, when you attempt to reconcile visit counts from the scheduled appointment vs. finalized notes, it is important to account for timing and delays associated with providers finalizing their notes. Click here to learn more. 

Incorrect Discharge Workflows

A less common reason for visit counts not matching between Patient Notes and the Notes by Clinic report results from practicing incorrect patient discharge workflows.

This typically occurs when the provider does not understand how to make a Discharge Summary note not billable. Instead of using a Quick Discharge note, or the Do Not Bill checkbox on the Discharge Summary, the provider will remove the note. 

When patients are incorrectly discharged by removing the patient note, the Patient Notes report doesn’t have a record of the discharged patient note. However, the Notes by Clinic actually shows the number of discharges in the visit count breakdown. This results in a discrepancy between these two reports as there is no patient note on the Patient Notes report for the Discharge displayed on the Notes by Clinic report.

Orthosis Daily Note

When comparing visit counts between the Patient Notes and Billed Units report, you may encounter discrepancies that are caused by therapists using Orthosis Daily Notes. There is no issue counting Orthosis Fabrication Initial Evaluation notes.

Orthosis Daily Notes are currently excluded from the Patient Notes report and do not currently count as a visit. However, the Orthosis Daily Note details are included in the Billed Units report, as there are billable units on the note. 

Reminder: While Orthosis Fabrication events typically occur within a single visit, it is possible for a therapist to complete subsequent Orthosis daily notes (i.e., adjustment on a splint).

Note: Orthosis Daily Notes are scheduled for inclusion on the Patient Notes report in July 2021.

Quick Add Patients

Quick Add is a great option for getting patients scheduled for an appointment with little patient information required. However, the therapist will not be able to finalize a note for the patient until the patient information is completed. This can create discrepancies when comparing the Scheduled Visits report to the Patient Notes report.