In this episode, we are joined by BESLER’s Mary Devine and Olga Barone-Allan to share their 10 best practices for revenue cycle during Epic and EHR installations.
Highlights of this episode include:
- Important best practices such as backlog reduction and understanding your baselines and metrics
- Why it is important for staff to be vested in the training they receive
- Why performing a full revenue cycle assessment is so important during an EHR implementation
- And more…
For more insight from BESLER’s experts on revenue cycle, listen to our podcast episode “Strengthening the healthcare revenue cycle” which discusses how creating cross-functional initiatives can improve the revenue cycle.
Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast.
Today I’m joined by Mary Devine who is the Director of our Revenue Cycle Services here at BESLER. And I’m also joined by Olga Barone-Allan who is our Client Relations Manager. And they are very close to our customers, particularly as they are in the throes of moving over to Epic and other EHR’s.
This is something we’ve talked about on the podcast before, really a couple of years ago now. And since then, we’ve had an opportunity to talk with even more customers and understand more about some of the changes that they go through that affect their revenue cycle during those implementations. And we wanted to bring those to you today.
So Mary and Olga, welcome back to the show.
Mary Devine: Thank you Mike.
Olga Barone-Allan: Thank you Mike.
Mike: So, along the way, you’ve kind of broken this out into 10 best practices, if you will, that you’ve noted. So why don’t we just through them in turn, and you can tell us about them.
So, the first one is: Don’t underestimate the implementation.
Mary: So, that is exactly what it says. People want to treat this like a project, an isolated project. And it really can’t ever be treated like that. It is a huge undertaking and people are generally going to be pulled from their day to day jobs and put on this implementation for several years. And it really isn’t a project that you start on one day, and 90 days later, you end it. You really must understand the huge undertaking that it is. Wouldn’t you say, Olga?
Olga: Absolutely, Mary. And I think the key thing to keep in mind is a representative of the key department really should be part of a team, a committee that really goes through the different phases of the implementation until everything is running smoothly.
And there also should be a designated person who is viewed as the key person overseeing and overall responsible for this committee.
Mike: Okay. So the next point that you make is: understanding your baselines and metrics. Why don’t you tell us about that?
Olga: So, in this area, what we have seen and heard from our clients is the importance of setting up key performance indicators. And why that is so important pre-conversion is so that you have a baseline to understand the different areas and how things are running today so that when you do convert, as you’re converting, and going forward after the conversion, you can see any trends or any areas that could be problem spots within the different departments.
And Mary will speak a little bit more in these specific areas where this is essential.
Mary: Absolutely! So, just some examples of essential metrics that, again, as Olga said, you want to understand before you go live and track closely after you go live, charges by call center, visits by call center, late charges, DNFB, claim accuracy and EDI edits and denials. Those are all key indicators that the conversion did not go as well as you planned.
And then, you just want to make sure that you’re tracking stuff like your ED visits. You want to make sure that you have a thousand ED visits a day prior to going live, that you still have those thousand visits post going live because those are some of the things that get lost.
Another big one is IME revenue. For all of you that are familiar with that, there is sometimes an issue with making sure that your IME bills are coming out appropriately as they concurrently come out with your MA claims.
So, just a couple of areas to really think about as you go live into Epic.
Mike: Great! And next thing is: performing a full revenue cycle assessment.
Mary: One of the things that we highly, highly recommend for all providers that are getting ready to go on a conversion over to Epic is perform a full revenue cycle assessment. You want to make sure that you understand how your revenue cycle is performing before you go live into Epic and begin that conversion so that it gives you the opportunity to add in best practice where you feel the revenue cycle system fall short.
I would recommend using a vendor. Wouldn’t you say?
Olga: Absolutely! An arbitrary person can always identify areas that, to the day-to-day person, would not be as obvious. So to avoid any kind of gaps in your cash collections or to avoid increase in AR days. You really want to make sure there’s somebody out there just on the sidelines really making sure that these numbers are not increasing to detriment the facility.
Mike: So, next couple of points, I guess they seem kind of elementary. They’re something that we’ve heard over and over again. And the first one is testing.
Olga: So, testing, we can’t say enough about it. And this is what we hear from all of our clients that have converted to the various EHR systems—testing every aspect of the conversion from the various departments, collaboratively between the departments, your charges, your DNFB, your bill drop. All of those areas are extremely key to the organization and to the revenue cycle.
Mary: Exactly! And just very quickly, to add in, we recommend parallel testing. And so before you actually cut over and go live, all the new processes that you implemented into Epic in that playground environment, you want to do the exact same thing in your current system and make sure that that playground is producing the exact same result that your current system does.
Mike: And perhaps leapfrogging off of that is training.
Olga: Training, again, you can’t get enough training. And probably training, train the trainer examples are the best. Assigning key people to be the advocates of the training, and then rolling that into the departments. And constantly having feedback with the vendor, the EHR vendor that you’re having, that you’re converting with.
Mary, do you have any additional insights there?
Mary: No, it’s important that people are vested in the training and they understand the importance of the training. So getting people certified and spending money on their training, if you will, and making sure they are vested is important to get the buy-in and the understanding, so that when you do cut over, everybody understands what they’re supposed to do.
Mike: Okay. So on-site presence at cutover, tell us about that.
Olga: This is really extremely important. A lot of EHR conversions, the facility does not think far ahead. Make sure that when you convert or sign a contract that you have in there that someone, a representative of the EHR program, is present after conversion for a period of time.
Nothing is missing charges or bills aren’t dropping, and now you have to call the hotline and try to get somebody dialed in to the system.
Having someone on-site present after go live is extremely important.
Mary: Yes, for sure. Exactly. You want somebody on-site that knows what’s going on. And more than likely, they’re going to know exactly what’s wrong, and they’re going to be able to fix it for you. You don’t want to delay that.
Mike: And you have some recommendations around that go live date as well.
Mary: Yeah, this is pretty simple. The best thing for your organization to do is to go live on the first day of the month. It just makes making sure that nothing is missing the easiest.
Olga: That is so important.
Mike: Tell us about backlog reduction.
Olga: Backlog reduction, any conversion, any type of conversion, it’s always key to make sure any kind of backlog is addressed. And if in your facility, you don’t have the resources, a possible opportunity is to outsource that. Get some additional help and make sure that your DNFB, your unbilled, your late charges. There isn’t a backlog. Otherwise, that’s going to cause havoc. And it would be very, very difficult to try to reconcile or track that information.
Mike: And then, you talked about legacy AR wind down.
Mary: The biggest thing about the legacy AR wind down is that we’d highly recommend that you do a post-conversion. You let your staff focus on the AR. And then, you probably outsource or have a dedicated internal staff focused on the old legacy. They’re not trying to work on two different systems. If you’re not bringing over the date and the log times providers, choose not to bring over the old AR and they just let it wind down, I would even recommend even farther than that using a vendor for that process just so your staff is not distracted into the old AR because it’s easier. Everybody is 100% focused on the new AR coming into Epic and keeping it current and moving forward in the right direction. So there is not a mess as it relates to bringing in cash. Wouldn’t you agree?
Olga: I’d totally agree with Mary on that. So important!
Mike: So, your last best practice, and perhaps arguably, the most important one is communication.
Mary: Yeah. In any undertaking of this size, communication is always the key to doing anything successful. And that gets set up from day one. You establish the communication necessary to get you through all the conversion items. And then if there are problems, you have a core group that everybody comes together on a daily basis or an hourly basis post-conversion and make sure everything is working right. It’s just really key to getting anything resolved and moving the project forward or the implementation in the proper way.
Olga: Yes. Don’t wait until a week later. As soon as you see something, immediately, you raise a flag because the repercussions could be a huge financial impact to the organization.
Mike: And no doubt, these implementations are huge in every way. And they affect hospitals across the country. So these best practices I think are very important to share. Thank you both for coming by today to do just that.
Mary: Thank you.
Olga: Thank you.