Spring has finally arrived here in New England and one of my “rites of spring” is getting the boat ready for the upcoming season. Within this familiar checklist and cadence, one of the most difficult issues is the identification and tracking down of water leaks. There are lots of potential places for a water leak in a 40-year-old sailboat - holes for this, fasteners for that, and original window seals. All of this needs to be assessed and inspected every spring before we put her back in the water for the summer season.
This recommissioning event and leak assessment can be likened to the steps to maintain and prevent revenue leakage within a health system’s EHR. According to the HFMA, most healthcare organizations (84%) rely at least partly on their EHR system for charge capture. Half use it exclusively as their charge capture solution. The charging process generally starts with physician orders for treatment and quickly progresses to tests being run, results being entered and charge codes flowing into the billing system. This process then assembles all of the data into claims or bills that then sent out to insurance companies for payment. It sounds simple, but there are thousand little issues (leaks of a sort) that can pop up. And in my experience, many organizations fail to holistically assess their EHR for revenue leakage each year.
Automated orderable testing – a best practice for shipshape charge capture
Finding errors in the charge capture process can feel like finding a rogue drip. Within the orderable charges, there are thousands of lines of code supporting these processes. And that is why routine automated testing is a best practice in charge capture validation and one of the first steps within a revenue integrity plan. As opposed to manual testing events where your clinical coding team reviews or spot checks these processes, automated testing can validate all the orderables within the EHR in short order and perfect accuracy. This information can then be utilized as the basis for further audits and revenue integrity approaches.
Best practice calls for automated orderable charge testing during critical milestones in the lifecycle of an EHR:
- During system conversion or upgrades. Moving to a new EHR or a version upgrade will necessitate mapping charge capture in the new system. All these lines of code will not translate from one system to another and it is necessary to test before go-live. It is also a great opportunity to streamline or redefine charge capture processes that can be improved in the newer version.
- When bringing on a new facility or ancillary service. While bringing on a new facility or service line isn’t at the same scale as a migration to a new EHR, the same mapping of charge capture processes applies in protecting against leakage. Also, it is an opportunity to build out charge capture workflows around orderable items that may not have had enough volume to justify the effort in the past.
- After pricing updates or regulatory changes. Every health system goes through annual pricing updates and changes related to CMS reimbursement requirements. These changes shouldn’t be dismissed as low impact. Typically these annual changes encompass hundreds of lines of code and justify re-testing.
- To establish a baseline for further revenue integrity audits or when there’s a question regarding the EHR orderable charges. While automated testing of the orderable charges within the EHR can validate the majority of revenue, this is one of the first steps in validating revenue processes within a greater revenue integrity plan. Further audits are needed for charges that are not part of the orderable set, supply chain, and other areas that significantly impact the revenue cycle for the health system, but testing the orderable set is the best place to start.
This type of audit or “recommissioning” will certainly help to ensure that the billing process runs as expected and not leak revenue. There are even ways to construct the system to include the tools that automate this testing, ensuring the seaworthiness of your revenue cycle.