EHR IMPLEMENTATION & REVENUE CYCLE

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Overview of the Revenue Cycle

The revenue cycle begins, for example, when a patient makes an appointment at a physician’s office or is admitted to the emergency room. It continues until the doctor’s office or hospital is reimbursed for services rendered—with plenty of steps in between. A fully optimized and customized EHR system can streamline the process, shortening the number of days in the revenue cycle.

Interim steps to effectively shorten the recycle cycle length include efficient appointment scheduling and/or patient registration. It includes checking each patient’s insurance coverage and eligibility for required treatments and the upfront collection of copays and deductibles. The process continues as care is provided and then the insurance companies and patients are appropriately billed and funds collected.

Revenue Cycle Slowdowns 

We’ve just described how efficient revenue cycle management works. Roadblocks to ultimate efficiency can include:

• Scheduling lag times with long waits for an appointment
• Patients not showing up to the appointment 
• Complex checking-in procedures
• Coding errors
• Billing errors and billing disputes
• Lack of quality reporting 

Note that the same issues that lengthen the revenue cycle also lead to lowered quality of patient care. So, addressing these issues will fix two core challenges at once. When they aren’t addressed, not only will both problems still exist, but the reduction in cash flow can lead to even more problems, which can have a further negative impact on patient care, as well as patient outcomes. 

Medical Coding and Billing Errors

According to an overview by Modern Healthcare, as many as 80 percent of medical bills contain errors. A 2016 report cited in this article notes how this problem is increasing: “Medical billing errors growing, says Medical Billing Advocates of America.” Mistakes, even when made with no ill intent, can have significant consequences. They can include patient overcharges and claim denials—adding stress right when patients need to avoid stress. 

From the healthcare organization’s perspective, this delays reimbursements, impacting cash flow and extending the revenue cycle. This, in turn, adds to the burden of insurance specialists and other employees in your organization. In more serious situations, it can lead to costly and time-consuming litigation. In short, even a seemingly small error can lead to significant emotional distress and undesirable financial repercussions. 

As medical coding becomes increasingly more complex (despite efforts to streamline them), incorrect or outdated coding can lead to insurance claim denial and rejected claims returned to the healthcare facility for corrections. Both processes can be time-consuming and both can increase administrative expenses. 

Coding errors can include current procedural terminology (CPT) codes; mistakes here can delay reimbursement or have it denied. Diagnosis-related groups (DRG) codes can trigger revenue cycle extensions, and so can incorrectly labeling a procedure as inpatient when it was outpatient or vice versa.

Fraudulent Billing

Although no healthcare organization wants to think this could happen at their facilities, the reality is that the National Health Care Anti-Fraud Association estimates healthcare fraud to occur in the tens of billions annually. Conservative estimates put fraud as 3 percent of total healthcare expenses while others put it as high as 10 percent. No matter which is accurate, this is too high of a cost that also damages the reputation of and trust in healthcare organizations. 

EHR Solutions 

When clinic EHR modules are seamlessly integrated with financial EHR modules, then healthcare organizations will have high visibility into their data. As each portion of the overall application is properly implemented, then claims management is streamlined in ways that enhance its accuracy. Data analytics presented in user-friendly reporting allows healthcare teams to identify potential sources of coding and billing errors and correct them. The ability of the software to compare claims against medical records helps to tackle potential cases of fraud, reducing both your risk and liability. Patient portals and automated reminders help to prevent missed appointments.

Here’s one problem example that EHR systems can address. The Healthcare Financial Management Association discovered that nearly 24 percent of claim denials occurred with errors or omissions in the prior authorization phase of revenue cycles. Prioritizing this as a focus in your EHR implementation processes, then, could be a significant time and money saver—and this is just one example of how seamlessly dovetailing EHR navigation to your organization’s workflows can be quite valuable.

Seamless EHR Implementation 

When your EHR system of choice is optimally implemented and integrated with your healthcare organization’s software, you can shorten revenue cycles and enhance cash flow. It’s vital, then, to choose the best electronic health records system for your needs and to select the most appropriate EHR modules, including those for revenue cycle management. 

Because each healthcare organization has different processes and workflows, it’s crucial that your EMR implementation—including all of its configurations and customizations—dovetails with your precise needs. 

As you create your implementation team, you may find staffing gaps in your in-house IT department or bandwidth challenges. If so, that isn’t unusual. After all, EMR implementation isn’t an everyday task.

The two best investments you can make, then, are the best EHR software for your needs and the right EHR team to maximize its benefits, including but not limited to revenue cycle management. Having a robust application is important, but you also need it flexibly tailored to your own workflows while avoiding potential pitfalls that could cost you time and money.

EHR consulting professionals in our deep and wide network have in-depth knowledge of—and implementation experience in—today’s best EHR systems, including:

• Epic
• Oracle Cerner
• Allscripts/Altera
• MEDITECH
• NextGen

Experts are available as consultants, contract to hire professionals, or permanent placements.

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