It’s easy to lose sight of what’s considered critical for continued success—that is, revenue—in the rush to transition from one electronic medical records (EMR) system to another. In a regulation-driven environment like health care, it’s vital that medical practices regularly take proactive measures to capture and retain revenue.
Constant revenue inflow is critical when you’re transitioning from one EMR to another—you need to ensure that practice operations are smooth during and after the process. Often, medical practices overlook revenue opportunities due to greater focus on adjusting to new EMR interfaces, navigation and templates.
Maximizing revenue isn’t just about coding your new EMR to perform a certain way; it’s also about deploying internal processes that ensure you don’t ignore revenue opportunities. It’s why small medical practices must include revenue cycle management among the top priorities during their EMR transition strategy.
In this article, we’ve listed three ways to avoid revenue loss during EMR transition.
Here’s what we’ll cover:
1. Identify Existing Process Inefficiencies to Fix Now
If your medical practice is suffering from process inefficiencies that aren’t directly linked to your existing EMR, then these issues could transfer to the new EMR as well.
For instance, if your staff isn’t accurately verifying patient eligibility, leading to frequent denial of insurance claims, then you’ll face this issue despite having a new EMR.
A 2017 analysis of U.S. hospitals found that of the nearly $3 trillion submitted in medical claims in 2016, almost 9 percent (nearly $270 billion) were initially rejected. Such a high denial rate creates roadblocks in increasing practice revenue. This is why it’s important to verify patient eligibility (using insurance verification and eligibility check features in revenue cycle management software).
Smaller practices could be even more affected by denied or rejected claims due to delayed revenue and smaller budgets on which they operate. However, it’s only one example of inefficiency in a medical practice. You could have other inefficiencies (such as staff not collecting co-payments) that can become bottlenecks even after deploying a new EMR.
Therefore, it’s best to get your existing process inefficiencies sorted before you begin the transition process.
For any additional queries, call us at (844) 686-5616 for a free consultation with a medical software advisor.
2. Engage Your Revenue Cycle Team at Each Step
To provide efficient patient care, you need to train your physicians and staff on using the new EMR system. However, don’t neglect your revenue cycle team. They should be engaged right from the start of the transition process.
Ideally, loop them in at each step of the new EMR implementation process. Your transition team should include clinicians, physicians, IT staff, vendor representatives and a member of the revenue cycle team, who can voice concerns about revenue inflow.
This way, the entire transition team can understand how the new EMR system would impact revenue generation. You’ll also have to train your revenue cycle team to deal with any process changes.
The following case study will help you understand the process of creating a revenue cycle team during an EMR transition.
South Shore Health System, based in Massachusetts, formed a dedicated revenue integrity department to track due diligence during its EHR transition. Bettyann Carroll, Executive Director of South Shore’s revenue cycle, was appointed to develop a revenue integrity program to mitigate any revenue losses in the short and long term.
GOAL: Avoid revenue losses during the EHR transition.
TEAM: The revenue integrity team included the following people:
- A director to provide leadership and oversight over the revenue integrity process to everyone.
- A revenue recovery analyst to find out the root cause of denials and drive process improvement.
- A charge capture analyst to help the clinical department understand revenue and usage reports as well as educate clinicians on capturing accurate claims.
- A revenue integrity analyst to educate outpatient clinic providers about accurate documentation and code selection.
SOLUTION AND FOCUS: To be successful, South Shore’s revenue integrity team focused on three areas—documentation and coding accuracy, accurate and timely claims capture, and denial and risk mitigation.
Before the EHR went live, the team focused on gathering a baseline of captured claims (such as type and volume of claims as well as revenue generation) in each department. It also met various clinical departments and IT staff to design optimal claims capture models. It also helped clinical departments train and prepare for the go-live phase.
Even during and after the EHR go-live phase, the team would continue to monitor the accuracy and timeliness of capturing claims, address revenue gaps and communicate regularly with clinical departments to ensure stable revenue generation.
RESULT: According to Carroll, the clinicians responded positively to the revenue integrity program. The revenue integrity team provides continuous clinician education, and meets one clinical department every month to discuss and solve their billing challenges. This would result in efficient and regular revenue inflow.
3. Communicate Revenue Cycle Importance During Transition
Patient care is always the top priority of physicians, irrespective of an old or a new EMR system. However, it’s critical for everyone to know that revenue cycle is also a top priority, especially during the EMR transition phase.
With revenue cycle management top of mind, you’ll notice fewer errors after prioritizing internal processes such as patient eligibility verification, preauthorization and claims denial management. You’ll also see higher revenue during and after implementation of the new EMR system.
Before the EMR transition begins, identify some key performance indicators (KPIs), such as insurance claims rejections, collection rates and claims denial rates. Regularly monitor the KPIs during the transition, so that you can make corrections easily.
Even after the EMR transition is complete, continue to monitor the KPIs for a few more weeks to check for any new problems. By closely monitoring critical KPIs, you can identify problems early on and fix those before the situation escalates.
The whole process of transitioning from one EMR to another requires a lot of hard work from everyone in your medical practice. For some, that’s a big ask. However, it’s absolutely essential because of the benefits you’ll gain from the new EMR.
The tips in this article aim to steer your practice smoothly toward new software adoption, while maintaining revenue flow. And remember the most vital step: Align your revenue cycle team with the IT staff and physicians throughout the process.
When you consider what’s needed to take that leap—keeping in mind continuous revenue inflow—it’s clear that it takes more than just luck or gut instinct for a smooth transition. Here’s a handy visual summarizing what you need to keep in mind during this process:
If you have more questions about EMR transition or which software to choose, our advisors can match your needs to systems that suit your practice. Call us at (844) 686-5616 for a free consultation with an EMR software advisor.