🇺🇸United States

Missed Charges and Coding Errors in E-Prescribing to Billing Workflow

3 verified sources

Definition

In prescription management, physicians document prescriptions and related services in EMR systems, but disconnected e-prescribing and billing systems lead to missed charges for ancillary services like lab work or injections tied to prescriptions. This results in unbilled services and undercoding, causing systemic revenue loss across practices. Studies show this affects outpatient clinics and physician practices routinely due to poor integration.

Key Findings

  • Financial Impact: $60,000-$100,000 per year for $2M practice (3-5% leakage); $300,000 unbilled in mid-sized clinic case
  • Frequency: Monthly
  • Root Cause: Lack of integration between EMR/EHR (where e-prescriptions are managed) and billing systems, leading to inconsistent charge capture and manual errors

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Physicians.

Affected Stakeholders

Physicians, Billers, EMR Administrators

Deep Analysis (Premium)

Financial Impact

$50,000-$80,000 annually (lost revenue visibility); potential compliance violations if care delivery is undercounted • $60,000-$100,000 annual revenue loss from undercoding ancillary services. • $60,000-$100,000 annually; 40-50% of missed charges never collected due to delayed billing

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Current Workarounds

Excel claims. • Excel patient charge sheets. • Excel.

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Patient Leakage from E-Prescribing Outside Network Pharmacies

Billions industry-wide annually from leakage (no per-practice figure, but essential revenue center loss)

Bottlenecks in Documentation-Coding Handoff

1.67% denial reduction = $36M savings potential

Under-coding and Missed Charge Capture in E/M Coding

$10M+ annually for mid-sized groups; 1-2% net revenue loss

Denied Claims from Improper Documentation and Medical Necessity Issues

15% denial rate; $36M recovered in one ROI case; >10% annual revenue for 40% of orgs

Extended A/R from Documentation-Related Soft Denials

$99K per provider/year in billing activities; multi-percentage points leakage

Fines from Documentation Breaches Tied to Coding Compliance

$4.75M settlement (Montefiore); $950K fine (Heritage Valley)

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