What it takes to launch Epic

Considering developing a new revenue integrity team? Imagine trying to do just that and implement the Epic EMR concurrently.

Christine Peet, RN, CCDS, COC, independent revenue integrity consultant in Port Saint Lucie, Florida, talks through the steps of launching Epic while developing a revenue integrity team. While this process differs by facility, one thing remains universal: it involves quite a learning curve.

“It’s just a tremendous undertaking to take a newly formed system of established independent hospitals, along with existing personnel, who had parts of the RI function, and put them together as a team. There is a need to understand any gaps in the function, and also understand the CDM needed for the Epic implementation,” says Peet.

One initial problem, she says, is developing the staff who do not necessarily understand the chargemaster behind the edits. While most staff know how to respond to specific edits, they may lack background information about the regulations and why these coding updates are required. In this situation, staff are often unable to identify similar scenarios where the same rule applies.

“If they’ve been many years, they have experienced the move from the business office situation to a revenue integrity department, and it’s not always easy to transition,” says Peet.

The transition from working in the business office finance department to performing within a revenue integrity team and maintaining the hospital’s chargemaster can be a steep learning curve. This is especially true when facilities rely on outsourcing to provide information on CPT® code updates. Understanding chargeability takes time, she says. It is therefore essential to identify and hire staff who have an enthusiasm for learning their role, says Peet. Because coding regulations are constantly changing, you want staff who will be eager to continue building their knowledge.

“Revenue integrity staff have to be able to find the information and apply the information to their particular situation. They need to continue to grow their own knowledge. It takes enthusiasm and knowledge to perform as part of a revenue integrity team,” she says.

During the transition to the Epic EMR the revenue integrity team has an essential role in the immediate go-live period to identify issues related to charging. Peet recommends having two revenue integrity teams on hand: a rounding team and an audit team.

The rounding team identifies operational issues with a charging focus and shares them with the IT and clinical department. This may include revenue reconciliation workflows, how to access the reports, and how to correct charges. Meanwhile, the auditing team will review charges on accounts to immediately identify any charge errors related to system and/or user deficiencies, she says.

During week one and two of go-live, these two teams work closely together to quickly identify and disseminate charging issues to the appropriate teams for correction. In weeks two and three of the GoLive period, the facilities transition the focus to the work queues to handle the high volume of edits in the queue. These work queues identify charging compliance issues that need to be quickly resolved in order to minimize the delay in billing.

“Epic is designed to move edits upstream, which can be very effective, but unless you’ve got the manpower to work them, you run the risk of backlogging claims processing. You’ve got to get the account edits cleared out of these work queues,” she says. “RI is key to reducing that transition time, and identifying and resolving issues so the AR doesn’t spike tremendously.”

It is imperative to the financial stability of the hospital that its cash flow is only minimally impacted by an EMR implementation. Therefore, if an EMR system implementation is successful, the accounts receivable (AR) spike will be brief and quickly smooth out to baseline.

“Having an established, experienced RI team and a strong corporate CDM “greatly contributes to a successful EMR implementation,” says Peet.

One lesson many facilities learn through the go-live Implementation process is how critical the revenue integrity rounding and auditing process is to the success of identifying and rectifying issues quickly to get claims processing again. This is all goes back to having the right group of people who can get the job done, she says. 

 

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