Master revenue reconciliation with interactive reports

Wednesday, August 28, 2019

Regular revenue reconciliation puts revenue integrity ahead of the curve by allowing it to monitor potential under- or over-reporting of revenue or charge capture issues. It also helps keep departments aware of their responsibilities and highlights areas that need improvement. But it can be an overwhelming task. Many organizations log thousands of patient encounters every day. Each encounter can generate numerous charges across several departments. How can revenue integrity scale a revenue reconciliation program that lets everyone work smarter—not harder—and ensures earned and expected revenue match up?

At Michigan Medicine, a multi-facility academic health system in Ann Arbor, Michigan, Karen Lehnert, director of revenue integrity, has implemented an interactive report built into Epic to help departments take ownership of reconciling revenue and charges while allowing her staff to monitor and providing education. Lehnert heads up a charge integrity team that’s responsible for defining and building hospital and professional fee charges, pricing hospital charges, and working with clinical departments to set up charge capture processes. Her team also handles testing and regression testing of new functions related to Epic upgrades and optimizations.

Individual clinical departments are responsible for capturing their own charges as well as for reconciling and correcting them within three business days, Lehnert says.

Each clinical department is assigned an analyst who serves as a resource to the department and can assist with revenue and charge reconciliation.

The interactive revenue reconciliation report can be utilized in different ways depending on the type and size of the clinical department. The report will generate a live display of the visit and the total potential, pending, and successfully filed charges, with an indication of whether the encounter has been closed by the provider. The report displays details for each charge, enabling a user to quickly review and determine appropriateness of charges, with links to documentation, work queues, and charge entry/correction information. Users mark encounters as they are reviewed, enabling leadership to track the reconciliation progress.

“Then the expectation is that, depending on the department’s size, they either 100% reconcile or they sample check or they look for trends,” Lehnert says.

Each clinical department is expected to designate a staff member who is responsible for revenue reconciliation. However, the priority a department places upon revenue reconciliation may vary based on staff members’ other availability. The designated staff member will have other duties, such as checking in patients or collecting money, that must be taken care of first.

“That’s part of the challenge and that’s part of why we like this interactive ability,” Lehnert says.

The interactive report makes it simpler for departments to monitor and correct charges and makes it easier for Lehnert’s team to monitor reconciliation by department.

“We should be able to go back and calculate what percent of encounters are being reconciled in various clinics. We’re really excited about that because we know that we can use that data and encourage the clinic managers,” she says. “It’s not hard to find accounts missing charges and impress upon clinic managers the importance of reconciliation. And on the flipside, we’re not just looking for missing charges. Sometimes they’ll enter a charge on the wrong account, so if we see that the patient was a no-show but there’s charges there, obviously that’s a problem as well. Or duplicate charges. It’s easy for departments to remove inappropriate charges.”

The interactive reports were relatively easy to implement and are user-friendly, according to Lehnert. Brooke Derrick, reimbursement manager at Michigan Medicine, was in the midst of updating the organization’s revenue reconciliation training materials as the interactive report was being implemented. That allowed Derrick to include information specific to the interactive report when she rolled out the revamped training. In addition, Lehnert’s team spread the word to other departments during their bimonthly revenue cycle forum. They are currently engaging clinical leadership as well, so that the message about the importance of reconciliation comes from the department’s leaders, not just revenue cycle.

Lehnert’s team also created an interactive elearning module that allows staff to practice using the interactive report. Because the elearning is available on the organization’s intranet, clinical departments can use it as a refresher and to train new staff without anyone from the charge integrity team taking time out of their day to lead training.

“We will continue in these bimonthly meetings and leadership discussions, to remind people of the importance of revenue reconciliation, because there’s always a lot of staff turnover and charge capture workflow changes in these clinics,” Lehnert says. “This is something you always have to stay on top of. You can never just pat yourself on the back and move on and say it’s done. Continued monitoring is critical because reconciliation is a necessary step of the clinical department workflow.”