Far too many providers are suffering a disruptive one-two punch to their bottom line. The first hit is the cost of an electronic health record (EHR)/electronic medical record (EMR) transition, which can run into the hundreds of millions to over $1 billion for a large provider network. The second hit is to the revenue cycle, with millions in revenue lost or delayed because the EMR transition plan didn’t treat clinical and financial systems as inseparable.
But you don’t have to accept this as an unavoidable cost of an EMR migration. You can ensure your clinical and financial systems remain inseparable by using these five strategies for maintaining healthy revenue during an EMR transition.
1: Give the revenue cycle management team a seat at the table
Seems like it should be obvious, yet it’s often missed. Providers who include revenue cycle management as part of an EMR migration can maintain positive financial performance during and after the transition. But EMR and revenue cycle management coordination can be complicated, and technical integration is a must. When planning an EMR migration, make sure your revenue cycle management leaders and your revenue cycle management vendors are part of the planning and transition team from day one.
2: Assemble a revenue cycle EMR team
You can’t have a seat at the table if you haven’t assembled a team and elected a leader to sit there. Pull your key revenue cycle leaders together—including the CFO, revenue cycle leaders from patient access and reimbursement, vendor representatives, and a “system liaison” representing revenue cycle—and establish roles and goals, a meeting schedule, and communication touch points with the EMR team. Most important, identify a project manager for the revenue cycle portion of the EMR transition. As a coordinated team, determine what processes, technology, and vendors will be used to manage each part of the revenue cycle process alignment and technology integration.
3: Make revenue cycle management a priority during the transition
You need to know how revenue cycle processes will be affected by changing EMR technology before the implementation. Specifically, providers should know how the new EMR will affect claims management workflow, staff utilization and speed of payment. To do so, be certain you understand how these processes will be affected:
- Eligibility verification
- Registration data quality assurance
- Pre-authorization and medical necessity management
- Pre-claim editing
- Medicare claims processing
- Secondary claims
- Claim workflow
- Remittance management
4: Keep an eye on your KPIs
There are several strong performance indicators that should be watched closely before, during, and after the EMR transition. Use them to establish your revenue cycle baselines before the EMR migration starts. Once the migration begins, determine the thresholds of variance for each key performance indicator (KPI) so that red flags are addressed immediately.
How fast are you getting paid? A/R days is the industry standard metric for EMR measure. Increases in A/R days usually indicates a process problem, such as how fast claims are getting out the door—which could be related to the new EMR—versus delays on the payer side. Finding the root cause of your slowdown and having easy-to-interpret data to share with stakeholders in problem areas is critical to making timely improvements to keep cash moving at pre-migration rates.
Days Not Final Billed
Days Not Final Billed (DNFB) is probably the best performance indicator because it shows how long it’s taking to get a claim out the door. It’s also the most likely KPI to light up early due to improper integration between the EMR and revenue cycle management systems. That’s why it’s crucial to establish integration points between the clinical and financial systems during the planning and configuration of the new EMR. Failure to do so might have a negative impact on the backbone revenue cycle process and cause DNFB to climb.
An EMR implementation can profoundly impact clinical departments. This KPI will help you see any delays from clinical impacts and will help pinpoint which departments might not be submitting charges as quickly as before due to unfamiliarity or problems with the new EMR.
Something is wrong when denials start to climb. Identifying the root cause early, and having the data to support appeals, can help get the affected processes back on track and the denial rate back in line. Establish alerts for timely filing thresholds to help ensure your team doesn’t miss filing deadlines.
5: Choose the right partner
Don’t go it alone. It’s not like you do an EMR transition every day. More like once in a career. Few revenue cycle leaders have the experience required to lead this charge alone. The best way to confidently transition to a new EMR is to remember that clinical and financial systems are inseparable and must be aligned and integrated. Most organizations can’t do this alone. It’s crucial to find an experienced partner who understands the challenges providers and their revenue cycle leaders face in the transition to a new EMR.
Ensure your revenue cycle partners are working together with your EMR vendor to help maintain payment velocity during and after your EMR transition. That’s the best way to help ensure your EMR transition doesn’t cost you twice.