Revenue Cycle Management: Key Steps in Preserving Revenue Integrity During Install

The EHR Implementation Go-Live Series

The biggest disruption in the RCM process is that the vast majority of charges (usually around 80%) are now actually entered by the clinicians themselves. Here is what your organization will probably look like post Go-Live:

• All areas are on a central, enterprise EMR. Best-in-breed systems have been largely retired. Separate interfaced systems may still feed the EMR, but charges flow from these to the enterprise system, and billing is managed centrally.
• Charge codes have been consolidated. Example: A charge code for a debridement is the same across all affiliates and all areas.
• Code requests and updates may still be requested from the departments, but they then need to be managed centrally because another affiliate may already be using the code.
• Clinicians enter most charges themselves through normal, clinical documentation. This is one of the largest transformative changes of an EMR installation. Change management of this area is critical, particularly because it is not always a focus of the vendors themselves.

Examples:

• Documenting that oxygen therapy started and stopped can drop appropriate charge in the background. 
• Documenting an immunization correctly can drop the charge for the administration and the medication of that immunization.
• Changing a patient’s status to observation can begin hourly observation charging.
• Documenting that a procedure was performed and some specifics around that procedure can charge for the correct procedure codes. The size of the wound determines the correct debridement code, etc.

Many CIOs and IT departments believe that RCM software also has to be completely updated following an enterprise EHR install to ensure positive revenue outcomes for both the top and bottom line. While some may find this necessary, a massive amount of the benefit garnered by an RCM system can be built for and accounted for in your existing EHR. The fault lies not with the system, but with its implementation.

Key steps in preserving revenue integrity during your install include:

1. Strengthening your existing RCM process and working through any issues. These will only be magnified with a large EMR conversion.
   
2. Preparing for process changes.
3. Consolidating charge codes across the CDM effectively. Preparing for the change to transition to a central CDM itself if multiple affiliates are moving to the same system.
   
4. Building a centralized governance system for managing both charging build and the CDM where one did not exist.
   
5. Creating a change management program around these large disruptions in the charge entry process.
   
6. Providing metrics, reporting tools, and dashboards to departments’ directors and managerial staff so that they can find issues with revenue generation. With charge generation occurring in all clinics and on all floors, issues may have to be managed locally. A central body can still work with engaged department managers to triage and resolve issues.
   
7. Training staff on how to enter charges themselves through normal clinical documentation, and training them consistently if there are multiple methods.

Note: Hospital Administration can also take these steps as part of a revenue optimization program after Go-Live.

Properly addressing each of these issues can mean the difference between a flourishing or floundering Revenue Cycle Management process after Go-Live. Correct planning, consolidation, and implementation of your system to ensure that every service, test, or procedure performed is charged for, goes a long way toward correct revenue generation and claims processing.