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5 Steps to Ensure Revenue Integrity After Implementing a New EHR

Posted on June 18, 2018 I Written By

The following is a guest blog post by Lisa Eramo, a regular contributor to Kareo’s Go Practice Blog.

In the rush to implement EHRs for Meaningful Use incentives, many practices lost sight of what matters most for continued success—revenue integrity, says Joette Derricks, healthcare compliance and revenue integrity consultant in Baltimore, MD. Revenue integrity—the idea that practices must take proactive steps to capture and retain revenue—isn’t a novel concept. However, it’s becoming increasingly important for physician practices operating in a regulatory-driven environment, she adds.

Revenue integrity is also an important part of ensuring smooth cashflow during and after the transition to a new EHR, says Derricks. This is a time when revenue opportunities are easily overlooked as practices adjust to new navigation, templates, and more, she adds.

Revenue integrity is all about compliance, says Derricks. “It’s about taking a holistic approach to operational efficiency, regulatory compliance, and maximizing reimbursement,” she adds. “It’s about doing things the right way.”

Maximizing reimbursement isn’t about ‘gaming’ the system to upcode. Rather, it’s about implementing processes and procedures to ensure that practices are paid for all of the services they perform without leaving money on the table or generating revenue that payers will later recoup, she explains.

Derricks provides five simple steps practices can take to ensure revenue integrity following an EHR implementation:

1. Review EHR templates. Do templates include the most specific CPT and ICD-10-CM codes? And do physicians understand the importance of avoiding unspecified codes, when possible?

2. Examine the interface between the EHR and practice management system. Do the codes that physicians assign in the EHR feed correctly into the practice management system? For example, when a physician performs an E/M service in addition to a procedure, does the EHR map both codes to the practice management system for billing purposes? Does the practice management system correctly bundle and unbundle services, when appropriate?

3. Run your numbers frequently. Ideally, practices will perform a monthly data analysis to help gauge performance and identify potential missed revenue opportunities, says Derricks. For example, she suggests running a report of the practice’s top 20 billing codes in a particular month. Then, compare those codes with the top 20 codes the practice billed that same month in the previous year. What has changed, and why? And have these changes benefited or hurt the practice? For example, practices may see new codes in that list because they added chronic care or transitional care management, both of which provide additional revenue. Or practices may discover a system glitch that incorrectly bundled services that are separately payable, thus causing a revenue loss.

“Everybody can play the ‘I’m too busy’ game, but this is too important to fall into that trap,” says Derricks. “I applaud the office manager or practice administrator who recognizes the value of constantly being on the lookout for system-wide improvements and analyzing their own numbers.”

Some practice management systems provide robust billing analytics that can help practices identify the root cause of billing errors and omissions. Working with a consultant is another option, says Derricks. Consultants provide unbiased input regarding inefficiencies and vulnerabilities and can provide a ‘fresh set of eyes’ necessary to effect change. They also often have access to benchmarking tools and other resources that can help practices identify revenue gaps and delays, she adds.

For example, Derricks suggests performing an assessment for revenue gaps and roadblocks to reduce the workflow process errors that delay revenue. Download the assessment.

4. Provide physician training. Physicians need thorough training on how to use the EHR properly so as to avoid data omissions, says Derricks. They also need annual training on new CPT and ICD-10-CM codes as well as new documentation requirements, she adds.

5. Create an environment that promotes compliance. This requires a top-down approach from physicians and practice managers, says Derricks. “Everyone should have their eyes open and feel comfortable being able to address concerns,” she says. “It should be an open-door policy in terms of looking at processes versus putting your head down.”

About Lisa Eramo
Lisa Eramo is a regular contributor to Kareo’s Go Practice Blog, as well as other healthcare publications, websites and blogs, including the AHIMA Journal. Her focus areas are medical coding, clinical documentation improvement and healthcare quality/efficiency.  Kareo is a proud sponsor of Healthcare Scene.

What could replace E&M coding to improve healthcare (and EMR)?

Posted on January 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A comment on my somewhat controversial thought post about imagining an EMR without billing reminded me that I wanted to ask the question of my readers about what could replace E&M coding. Seriously, I can’t think of anyone I know that actually likes E&M coding. I know some people that are good at it and so they like that they have a skill in that area. However, I don’t remember anyone being a proponent of E&M coding because it provides better patient care or makes life easier for doctors. Am I just missing these reports? So, this leads to the important question…

What could replace E&M coding that would improve healthcare and still handle billing?

Plus, after you read the comment below, you’ll understand why improving billing could also improve many of the billing machines EMR software that’s out there as well. Let’s hear your thoughts.

Here’s the comment that prompted this thought:

The broader problem is that the billing aspects have many more insidiously negative effects than simply sending a charge transaction across an interface.

They actually degrade the quality of the documentation by requiring certain elements to support specific levels of billing. The whole issue of needing to have a certain number of elements done and documented to bill a particular E&M code is one example. A particular visit may have extremely complex history/assessment/decision-making but to get “credit” one also has to document a certain number of irrelevant review of systems items.

It is no surprise that the places that have used EHRs most effectively such as Kaiser and the VA are incentivized to give care that will produce better outcomes. They are less beholden to bureaucratic insurer-driven documentation demands that do not aid in patient care or communication.

Eliminating all of these items (and similar demands for information to fulfill PQRI and other measures that are irrelevant to a particular patient or that fragment thought processes) would improve workflow and efficiency in any system, paper or electronic. It would certainly make it easier to develop an EMR that would support patient care needs.

But just having distinct EMR and billing software isn’t going to do the trick in our current dysfunctional health care system. It is only if an EMR can be designed (and insurer/payor/regulatory demands can be synchronized) so that the health care system looks like a single payer system to the EHR user and clinicians can go about the business of treating patients.

It’s a little bit pie in the sky thinking, but sometimes that’s beneficial.

EMR Billing Matters

Posted on August 25, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My previous post about imagining an EMR that didn’t include billing certainly has driven a lot of conversation. Actually, that was the purpose of the post. I indulge in great conversation with multiple perspectives. It’s the beauty of blogging and of life.

However, please don’t let that post confuse you. Billing is an absolute essential part of an EMR software. There’s a very good reason why most EMR software out there amounts to little more than a big billing machine. The demand for healthcare software was initially to solve the challenges associated with medical billing. Markets are great at satisfying demands and that’s why the EMR software is the way it is today.

This means that EMR vendors CANNOT ignore billing. Rightfully so, doctors want to get paid for their work.

Of course, the point of the previous post was to try and expand the conversation beyond billing. Basically, the goal was to try and imagine an EMR software world where patient care was the focus instead of billing. What kind of good could we accomplish if this was our goal?

This follow up post was prompted by this somewhat disturbing email I received:
“I have built just such an EMR product for the iPhone and iPad. I am struggling with financing it because everybody wants billing. They really don’t care about the quality of the EMR.”

I’d make one qualification. No one cares about the quality of the EMR, if you don’t satisfy their billing needs too. Reminds me of HIPAA. No one would purchase an EMR that didn’t meet the HIPAA standards. However, once they hear it meets those standards, they move on to other things like the quality of the EMR.