The Devil is Lurking in your System Dictionaries

By: Jeffrey DiLiddo

Categories: Billing, PMG Insights Blog

December 26, 2013

When is the last time you did a review of your system tables and dictionaries? Are you confident they
are accurate and up to date?

I can tell you with the utmost confidence that a majority of your rejected claims, denials, and systems
problems are due to misconfigured system dictionaries or poor data quality. Most Administrators that
we meet have no idea what is lurking inside those areas of their EMR/PM system. They might have a
third party “managing” their system or their software vendor or even an internal I.T. staff member
responsible for those tables… but do they really know what is inside?

Here are some questions to consider:
‐ If you were to run a provider report from your billing system today, how many inactive providers
would it have on it?
‐ Have all of all of your facilities been properly tied to the Encounter Rate dictionary for the current
year?
‐ Which denial reason codes have been set to auto adjust in your system?
‐ Is your Encounter Rate current?

If you can’t answer any of those questions, you should take a look at whom (if anyone) is in charge of
maintaining these tables. If multiple people have the access and system credentials to edit your tables,
the situation could be even worse. The accuracy of the data in these tables is likely to be a key
contributing factor if you are not seeing the billing performance you would like. On top of that they can
render your reports inaccurate as well, hamstringing your ability to make data driven decisions.
There is an important relationship that exists between your Billing, Coding and I.T. staff. Your I.T. staff
might know the best way to configure your PM system according to your software vendor, but they may
not be experts on the local regulations and intricacies that can affect that configuration. Your billing
staff might be pros at local billing regulations, but they have no idea how one system table/dictionary is
dependent on another. Your coder might know how to find every last revenue opportunity in each
service your providers perform, but may not be able see that through the restrictions in the system ~or~
regulations.

It’s very likely that you have one person who is “adequate” at all three, but just doesn’t know enough
about what your system is doing that is preventing you from getting paid. Our sole purpose at Priority
Management Group is to learn the relationships between your process, systems, regulations and people
so that your system can be configured to support those relationships.

We’ve met a lot of folks who are just looking to make sense of what their EMR or Practice Management
systems are doing, so if you are feeling in the dark about those things you are not alone. Whether an
outsourced solution is right for you or not, having a process for ensuring that your system dictionaries
are primed for peak performance is essential.