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Epic Conversion - Revenue Cycle Lessons Learned

Electronic health record (EHR) implementations can be operationally invasive and can have significant financial implications. Organizations may see a reduction in net revenue, an increase in accounts receivable days and a slowdown in cash collections. With several NJ providers in the process of moving to an Epic HIS and EHR environment, preserving net revenue, maintaining consistent cash and ensuring accurate financial reporting should be among the provider’s primary conversion goals. We have worked with several providers throughout the country who have undergone a recent Epic conversion and thought it would be beneficial to share conversion lessons learned from these providers. A consistent phrase in the Epic conversion world is ”Big Bang,” indicating that every module that’s been purchased is implemented at the same time. The conversion timeline is an eighteen month journey and has been described as a conversion like no other. More and more providers are moving towards the “Single Billing Office” (SBO) solution, meaning hospital, physician and potentially other entities such as home health appear on a single statement. This alone is a significant change for hospital providers.

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Epic Conversion - Revenue Cycle Lessons Learned

  1. 1. Fall 2016 • vol 63 • num 1 new jersey chapter Celebrating the 40th Anniversary Annual Institute Special Edition: NJHFMA Annual Institute in Atlantic City October 5-7, 2016
  2. 2. Fall 2 0 1 6 Focus 9 Epic Conversion – Revenue Cycle Lessons Learned Kathy Ruggieri by Kathy Ruggieri and Mary Devine Electronic health record (EHR) implementations can be operationally invasive and can have significant financial im- plications. Organizations may see a reduction in net revenue, an increase in accounts receivable days and a slowdown in cash collections. With several NJ providers in the process of moving to an Epic HIS and EHR environment, preserving net revenue, maintaining consistent cash and ensuring ac- curate financial reporting should be among the provider’s primary conversion goals. We have worked with several pro- viders throughout the country who have undergone a recent Epic conversion and thought it would be beneficial to share conversion lessons learned from these providers. A consistent phrase in the Epic conversion world is ”Big Bang,” indicating that every module that’s been purchased is implemented at the same time. The conversion timeline is an eighteen month journey and has been described as a con- version like no other. More and more providers are moving towards the “Single Billing Office” (SBO) solution, mean- ing hospital, physician and potentially other entities such as home health appear on a single statement. This alone is a sig- nificant change for hospital providers. Lessons Learned 1. Don’t underestimate the implementation Do not treat the Epic implementation like a project. Some providers felt they did not initially dedicate enough re- sources to the conversion. The conversion to Epic is a stra- tegic commitment that may require partnership with an ex- ternal consulting group to assist with the implementation. 2. Understand your baselines / metrics Epic provides user-friendly dashboards to analyze key per- formance indicators (KPIs) and metrics. However, com- paring pre-conversion metrics to post-conversion metrics is critical in identifying conversion disconnects. Metrics that are consistent and trended over time illustrate the best historical picture. Therefore, a full complement of com- parative pre- and post-conversion KPIs allows providers to know where they should be at system cutover. Since the conversion timeline extends over eighteen months, there is time to fine tune or implement KPIs to effectively monitor post-conversion trends. Ex- ample essential metrics are: • Charges by cost center • Visits by cost center • Late charges • DNFB trends • Claim accuracy • EDI claim edits • Denials • Payer payment trends (specifically, how fast you are paid) These are just a few recom- mended metrics. Every pro- vider we have spoken with can’t stress enough the importance of monitoring comparative metrics daily, at time of cutover and going forward. This was a deal breaker for many facilities. Some examples of conversion disconnects identified through the analysis of comparative metrics: • IncreaseinSelfPayEDClaimsPost-cutover – Pre-con- version self-pay visits compared to post-conversion visits revealed a significant increase in self-pay ED visits. The analytics platform identified the trend im- mediately and an error had occurred with the appropri- ate mapping of the insurance plan. The ability to com- pare ED visits by payer, pre and post conversion, facili- tated the ability to promptly correct the disconnect. • Decrease in IME Revenue – Historical revenue reports revealed a 40 percent reduction in IME revenue post conversion. This was unexpected since Epic automati- cally generates a shadow bill when the Medicare Advantage claim is billed. It was later identified that not all plans were flagged as Medicare Advantage during the build. • ChargeCapture–Theabilitytotimelyidentifycharge capture disconnects is essential. For example, if there is a 1% difference in historical gross charges within 24 Mary Devine continued on page 10
  3. 3. Fall 2 0 1 6 10 Focus continued from page 9 hours from cutover, the issues must be identified and resolved immediately. These types of issues can spiral into much larger problems. It is important to remem- ber that an EHR implementation is life-changing for your clinical areas and errors can and will occur. 3. Perform a Full Revenue Cycle Assessment Some providers invest in a full assessment to review the en- tire revenue cycle continuum prior to conversion, in order to assess revenue cycle workflow efficiency. With a goal of optimal efficiency and collection, work flows are changed to prevent revenue leakage prior to conversion. There are others who might take the opportunity to incorporate the approach of looking at the revenue cycle from the patient experience perspective. 4. Testing The common response we heard with regard to testing is “Test, test and test some more, you can’t test enough!” Paral- lel testing was a common practice, running claims through the legacy system and Epic to ensure the outcome was the same. Parallel testing also allows for the creation of addi- tional upfront edits to improve the overall clean claim rate. 5. Training With regard to training we also heard a common response of “you can’t train enough.” Some providers went the route of appointing a credentialed trainer which was over and above the vendor training. Several providers felt it was es- sential to not only provide system training on the new func- tionality but to also include training around the workflow processes so the staff understood the workflow mechanics and not just the tasks themselves. Since the new system was significantly different than the legacy system, this was a critical piece. It was certainly more time-consuming, but a worthwhile investment as the users were ultimately more well-rounded to the system function and design. 6. On-site Presence at Cutover It is beneficial to plan to include a few billing staff on-site when the system converts. Granted, this will require some juggling of schedules to staff at midnight but it is well worth the effort. Billing staff are able to concurrently identify in- terface and charging issues within the first few hours of the conversion. 7. Go-live Date You might avoid glitches by going live with your conver- sion on the first day of the calendar month. Otherwise, for example, be prepared to address the potential financial re- porting disconnects resulting from your recurring accounts. 8. Backlog Reduction Reduce all backlogs prior to conversion. This would in- clude denials, unbilled accounts in the EDI platform, unapplied cash, coding, etc. Some providers dedicated ad- ditional resources to the overall reduction of the DNFB. 9. Legacy AR Wind Down Many providers utilize an outsourcing partner post conver- sion. However the timing of the outsourcing varies. Some multi-entity system providers who outsourced at ninety days felt it was too late, others outsourcing at day one felt it was too early. It is important to determine the best out- sourcing timeline utilizing historical “days to pay” metrics and volumes. 10. “Release of Information” Coordinate with HIM to ensure special attention is given to “Release of Information” when setting up the bills. Scenarios can occur where an entire patient’s record is print- ed versus a sole visit or vice versa. 11. Communication It is imperative that post-cutover issues are acted upon im- mediately. An effective communication plan should also be a component of the conversion plan. Conclusion Conversion planning, testing, training, monitoring and communication are the critical components to minimizing financial impact. About the Authors Kathy is responsible for BESLER’s Revenue Cycle service line and has been a member of the Revenue Cycle team for over fifteen years. Kathy has over 25 years of experience in healthcare financial management and has extensive knowledge of all components within the revenue cycle. Her background is very diverse, with experience in acute care hospitals in addition to skilled nursing facilities, psychiatric facilities and home healthcare. Kathy created the Medicare Transfer DRG Revenue Recovery Service in 2007 and expand- ed the service to include Medicare Advantage and other payers in 2011. Kathy has selected and mentored our multi-disciplinary team and guided the creation of our proprietary software solution that has positioned BESLER as a national transfer recovery partner. She has managed and participated in numerous client projects related to patient access, accounts receivable reduc- tion, interim patient accounting management, central business office devel- opment and implementation, cash acceleration and charity care evaluations. Kathy can be reached at kruggieri@besler.com. Mary is responsible for the Transfer DRG service and has been a member of our Revenue Cycle team for over eight years. Mary applies her clinical ex- pertise to our underpayment decision making. She is involved in all of our engagements and provides mentorship to our validation team. Mary also has extensive background in appeals, which includes working with hospitals on inpatient and outpatient appeals for managed care and Medicare. She also has experience with Medicare at the Provider Reimbursement Review Board level. Mary is an RN with clinical experience in acute care and long term care, as well as for large teaching institutions. Mary is also an expert in the Revenue Cycle and was an Assistant Vice President of Revenue Cycle for a large health system in New Jersey. Mary can be reached at MDevine@Besler.com. If you would like additional information regarding this article, please contact Kathy Ruggieri at kruggieri@besler.com or Mary Devine at mdevine@besler.com

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