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Maintaining and improving collections during an EMR implementation

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Maintaining and improving collections during an EMR implementationWhether your organization is contemplating an electronic medical records (EMR) installation or is far along in completing one, know that you’re in good company if you’re concerned about a performance lapse in the revenue cycle. It’s a common and worrisome byproduct of an enormous undertaking that comes at the expense of attention to day-to-day activities and, consequently, often results in a lag in financial performance.

It is a given that an EMR system is a valuable asset, and virtually all health care organizations have or will adopt EMR for its indisputable benefits to the organization and patient alike. The trade-off of a lapse in collection efficiency — at least in the short term — may appear inevitable, but the negative effects can be minimized by adhering to leading practices. Based on years of assisting clients and transforming revenue cycle operations, Health Care Advisory Services Partner Lane Jackson responds to FAQs with recommendations to maximize efficiencies in your revenue cycle before, during and after go-live:


Q: What are leading practices for an organization that is about to begin or is working through its EMR implementation? 

A:
  1. Before beginning EMR implementation, reduce revenue cycle backlogs.
    Clear the decks as much as possible in key areas. For example, discharged but not final billed accounts should be reduced to best-of-practice levels before a go-live.
  2. Establish a transitional organizational structure.
    Within your business office, create a temporary structure for conducting billing and collection efforts. Realize that day one work requirements between systems — legacy and new — will differ greatly from requirements at day 90. Plan for this change by establishing a transitional organizational structure and making personnel aware of the approach.
  3. Decide how you will utilize vendors and third parties.
    You will almost certainly need outside assistance to supplement your internal resources. Expect to reallocate resources for the EMR installation; additional assistance is important to accomplish tasks that would otherwise be neglected. Evaluate how vendors will be used to minimize a drop-off in financial performance, and determine the most effective time to begin utilizing or expanding the utilization of vendors.
  4. Prior to EMR go-live, repeatedly test the claims submission process.
    Test, test and test again until it is proven that bills will be generated and sent out to payors when you reach minimum hold days. The ability to submit clean claims in a timely way has the most substantial effect on revenue cycle performance.
  5. At EMR go-live, aggressively monitor key performance indicators.
    Immediately after go-live, begin monitoring key performance indicators, with charges as the primary focus. You should anticipate and validate that revenue is the same as it was in the previous system. Identify fluctuations and watch for red flags. If the charges are not entered, financial performance will suffer. Don’t wait until the end of the first week or month to monitor, or to act.
Q: What are leading practices for an organization that has completed its EMR installation but whose performance isn’t as hoped? 

A:
  1. Revisit the organizational structure.
    Ensure that your resources and efforts are aligned properly, and that personnel work efficiently and effectively both in the legacy and the new EMR system.
  2. Identify and resolve EMR build issues.
    Connect frequently with system users to learn about what is and is not working well. It is not realistic to try to fix everything at the same time; instead, prioritize optimization activities that drive the most value and have the most effect on revenue cycle performance.
  3. Utilize vendors and third parties as needed.
    Backlogs and other issues can force internal resources to continuously deal with problem-solving rather than moving forward with the new process. At any point, engage outside assistance to allow your personnel to catch up with their work and settle into their new routine.
  4. Refocus and re-energize.
    After what will be a vast amount of sometimes exhausting change, resources can lose their steam. It is critical to financial performance that attention is returned to the day-to-day activities of running the revenue cycle.  

A successful case in point
“We needed a consultant that could quickly survey our organization and processes, develop a plan of attack and help us execute. Grant Thornton did just that, and more… In summary, today most of our revenue cycle metrics are in the top quartiles of the country.” Steven M. Wright, CFO, University Hospital
With diligent oversight, your financial performance should produce better-than-historical results. This was the case for the State University of New York (SUNY) Upstate Medical University, which had experienced lagging cash collections and a rapidly aging accounts receivable.1 Hospital staff teamed with Grant Thornton professionals to build and implement a best-of-practice revenue cycle to coincide with an EMR implementation. Results included optimized revenue cycle processes with cash baselines recovering in less than half the average time, significant additional one-time cash generated prior to EMR and patient accounting system go-live, and considerable additional revenue on an annual recurring basis.

1 Jackson, Lane, and Oliver, Matt. Academic Hospitals Gains Best-of-Practice Revenue Cycle, Jan. 16, 2015.