One could say that maintaining and preventing revenue leaks within a health system’s EHR is a similar exercise to preparing to sail.
My beloved sailboat is 43 years old now. You can imagine how a lifetime of sailing adventures has stressed her fittings, connections, and bits. Years of adventuring in New England seas and storms have caused Solstice to be – well a bit leaky — weeks of work are in this annual exercise to detect and address the sources of wetness and moisture. All leaks need to be repaired before we safely sail again.
How charge capture works in an EHR
According to the HFMA, 84% of healthcare providers look to their EHR for most of their charge capture. Half of them said they rely on their EHR exclusively.
The charging process generally starts when a physician orders treatment. Tests and results follow and charge codes flow into the billing system. This process assembles all of the data into claims or bills that are sent to payers and insurance companies for payment.
It sounds simple, but there are thousands of little issues (leaks of a sort) that can pop up. In my 30+ years of experience, many organizations fail to assess their EHR for revenue leakage — holistically and annually. Small leaks can turn into huge revenue loss when viewed over time.
Manual testing events are too flawed
Finding errors in the charge capture process can feel like finding a rogue drip. Thousands of lines of code support the processes behind orderable charges. Manual testing events would involve your clinical coding team reviewing or spot checking these processes. They would need to carefully go through application screens, trying various input combinations, comparing the results to the expected behavior.
This is not only a productivity drain, but a flawed process. Spot-checking can’t verify the volumes of line items available in a facility. Manual methods deliver a less than ideal experience for financial decision makers as well as billing and coding personnel.
Automation tool helps uncover revenue leaks
Today’s best practice: use a routine automated financial testing solution for charge capture validation.
Automated financial testing can validate all the orderables within the EHR quickly and efficiently and with perfect accuracy. Our team of MEDITECH-ready certified experts have built our automated testing solution that results in 100% validation of process-driven orderable charges and has helped healthcare organizations through the process in as little as 15 days.
One of the first steps for implementing a revenue integrity plan should be taking advantage of the Automated Financial Testing Core Solution that CereCore provides. Plus, these results can be used as the basis for further audits and revenue integrity approaches.
Reasons to perform a revenue integrity audit of your EHR
Critical milestones in the lifecycle of an EHR can serve as triggers for validating your orderable charges. Below are a few best practices that will support your revenue integrity initiatives:
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 of the EHR.
When bringing on a new facility or ancillary service. While bringing on a new facility or service line isn’t the same scale as migrating to a new EHR, it could be a great 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.
Get help with the audit
This type of audit or “recommissioning” will certainly help ensure that billing processes are running as expected and not leaking revenue. The best part: CereCore’s Automated Financial Testing Core Solution is just the service needed to automate the testing process — ensuring the seaworthiness of your EHR's revenue cycle.
Meet Lynn Falcone, a rural healthcare CEO, with over 30 years of experience in healthcare operations, most of which was spent working in large urban settings. Today, she is the CEO of Cuero Regional...