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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.

EMR Templates

Posted on September 6, 2012 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m always fascinated by a discussion of EMR templates. A little while back on the 3M blog, they wrote what I think is a pretty good summary of the pros and cons of EMR templates:

Using template-based documentation provided by most EHR vendors allows for documentation to be available almost immediately for communication with the rest of the care team, which is important especially for daily progress notes. Choosing templates over dictation-transcription eliminates the variable of transcription turnaround time, which can range from a few hours, to a day or more. Templates also allow documentation to be created in a consistent and structured format, with up-to-date problem lists.

There are clearly many benefits associated with the use of templates, however from what we’re hearing there also are a number of drawbacks to this strategy. Coding, communication with other care providers, and physician efficiency can all be impacted by template-based documentation. We’re seeing that physicians don’t capture as much information when they fill out a form-based template as they do when they are allowed to capture the patient narrative in their own words, either through writing or dictating. Key information may be missing, which impacts both the care team and coding—and could result in the dreaded “every patient looks the same from the documentation” issue. Some physicians tell us that templates slow down their daily workflow, making them frustrated with their organization’s EHR implementation.

The discussion of EMR template use is a complex one. In many cases you can see the benefits of using an EMR template, but there are also a lot of downsides to their use. I remember when Dr. West wrote a blog post about why he loves his EMR templates. As I thought about his views I realized what the difference was in his templates and the templates that many other doctors use. He created his own EMR templates that were specific to him. I think that makes all the difference in the world.

Turns out that no one really hates EMR templates or loves EMR templates. They’re just a means to an end. What then are the benefits and challenges of using EMR templates.

EMR Template Benefits:

  • Saves Time (if designed well)
  • Helps Ensure Standard of Care
  • Documentation Always Found in Same Location on the Page

EMR Template Challenges

  • Every Chart Looks the Same
  • Lots of Clicks (if designed poorly)
  • Abnormals are Difficult to Identify
  • Difficult to Document Multiple Chief Complaints
  • Template Not Physician Specific (or takes a lot of time to create ones that are)

I’m sure there are other points worth noting. I look forward to hearing which ones I might have missed in the comments. I think the key when considering templates is how to make sure you get the benefits while mitigating the down sides. I think this is possible, but it takes some time and a thoughtful approach to make it happen.

Common EHR Implementation Issue – Inadequate EHR Templates

Posted on September 6, 2011 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the latest entry in my series of Common EHR Implementation Issues. See also my previous posts on Unexpected EHR Expenses, EHR Performance Issues and a little follow up to avoiding the EHR performance issues altogether.

This weeks common EHR implementation issue is: Inadequate EHR Templates.

Before I begin with the major issues of inadequate EHR templates, it’s worth noting that there are a few EHR software out there that use a different EHR documentation paradigm than templates. For example, some use voice recognition to power their documentation. Others have a system that learns your documentation over time and based on that learning remembers how you want to document certain procedures. Others, use lots of independent documentation methods (one EHR vendor calls them controls – check box, radio button, freetext field, etc.) which can be grouped and used in interesting ways.

However, even with all of the above alternative documentation methods, there’s often an element of templating that’s occurring. They’re PR and marketing people will shudder at the term template, but concepts related to templates seem to pretty much always apply. For example, in voice recognition there’s something called a Macro. That’s basically a template. The EHR system that learns your documentation method is just using your initial documentation in the EHR to create personalized templates of how you like to document. The independent documentation methods often group those various “controls” into groups of common visits. That sounds like a template to me.

I’d be interested to hear of an EHR system that doesn’t use the principles of templates. It is worth noting that all EHR templates aren’t created equal. Some are much more flexible than others. Now to some details.

The inadequate EHR templates shows itself in a number of different ways.

No Specialty Specific EHR Templates – This has to be the complaint I hear the most. It usually goes something like this, “The EHR salesperson said they had templates, but they don’t have any templates I can use.” Did someone say EMR salesperson mis-communication? Yep, happens all the time. Let’s be honest for a second. How could the EHR salesperson know how good their cardiology or neurology templates really are? They just go by what they hear and what they’re told by the EHR company.

Incomplete or Unusable EHR Templates – You may have noticed a subtlety in the quote I put above. At the end the doctor says “templates I can use.” Maybe the EHR salesperson isn’t lying to you about them having those cardiology or neurology templates. Maybe they do have a bunch of templates for those specialties (or whatever specialty that interests you). However, just because they have templates for those specialties doesn’t mean that you’re going to want to use any of the templates that they’ve created.

My favorite complaint is when they say that the specialty templates seem to have been created be a general medicine doctor and not an actual specialist from that field. I’ve heard it far too much not to mention it.

The other major problem with this point is the unique documentation preferences of each doctor. Has there ever been any two doctors that document the same way? We could debate the good and bad merits of such documentation, but the point is that each doctor is very different. Some feel the need to over document the encounter. Other doctors want to just document the bare minimum. Plus, some (purposefully or not) do a terrible job documenting the visit. The templates in an EHR could reflect any of these various documentation patterns and depending on your perspective could mean that EHR has inadequate templates for your needs.

Hard to Modify, Add to, or Adjust – While not specifically an inadequate template, this is an important part of templates. Turns out that if a user can easily modify, add to or adjust a template that is inadequate, you’re going to be a lot better off. Some template systems are like pulling teeth to modify. Others are amazing at how you can on the fly modify the template.

One promise I can make you, You WILL want to modify their templates. I can’t say I’ve ever heard of someone using the templates perfectly out of the box. Well, maybe I’ve heard of one or two using them, but that was when they were complaining that they had no way to modify the things they wanted to change.

Avoiding EHR Template Inadequacies

The best way to avoid this issue is to test drive the EHR software and the specialty specific templates you hope to use. Run through the templates like you’re charting on some common patients. You’ll learn a lot about what templates are available doing this than anything else. You’ll see if the templates are overkill or below standard for your needs.

Another great test is to try using multiple templates for a complex patient. How easily is that done and how well does the documentation display?

Then, during your EHR demo with the EHR salesperson, ask them to modify part of the EHR template they’re using to document. Tell them you don’t like to ask one of those questions, so you’d like to see them remove it from the template. Many are likely to respond, “It can be done, but I’d have to switch systems to do it or I’d have to call in to tech support to make the change.” I think we all know the real message they’re sending.

For those not interested in EHR templates, you might take a second to read Dr. West’s Experience implementing EHR templates in his office.