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Dollars and (common) sense: Why making RCM a priority during your EHR build is critical

Fred Morgan, Senior Director of Physician Patient Accounting, Mercy Health Systems
Fred Morgan, Senior Director of Physician Patient Accounting, Mercy Health Systems

Few health IT implementations are as expensive, complex and involve as many stakeholders as an electronic health record – and it’s even harder when you’re up against an aggressive deadline. That was the situation we were facing at Mercy Physician Enterprise, which is part of a larger healthcare network, Mercy Health Services in Baltimore. In order to attest for Meaningful Use and improve our reporting, we decided to replace our legacy system with a new system (Epic) in under 12 months.

During an EHR build, it’s natural for an organization to put considerable focus on clinical functionality. However, the line between clinical and financial data isn’t as bright as it once was, and a significant indicator of a successful go-live is providers’ ability to effectively manage payments and claims.

We decided to make revenue cycle management (RCM) a high and continuous priority in order to identify and mitigate any issues during the course of the build. With an implementation of this scale, the impact on cash flow is always going to be a concern. New EHRs often cause changes in charge capture and billing processes, and there is the ever-present risk that something will go wrong, leaving you unable to get charges out the door.

By focusing on RCM early, we could establish a performance baseline for claims and revenue management, and ensure that Mercy could seamlessly administer payments and claims and maintain our financial performance during the transition to the new system.

What made our strategy work was having a long and proven partnership with our RCM partner (Availity). When implementing a new EHR, hospitals sometimes institute wholesale changes to their IT, which often means new vendors, new solutions, and new uncertainties. However, a proven relationship with an existing partner can make a huge difference.

Any hospital or health system has business/clinical needs and cultures that make them different from other organizations. A partner with deep knowledge of the unique aspects of your organization not only will help you avoid common mistakes, but also keep you focused on detailed integration points and workflows for submission of claims, electronic attachments, converting paper claims, eligibility, remittances, and payment auto-posting.

A partner that knows your organization also helps new vendors get acclimated, provides guidance, and ensures everyone stays accountable. A positive and fruitful collaboration allowed us to establish claim benchmarks and ensure that work-queue configurations were optimized to mitigate missing or lost claims.

We realized tremendous success with our claims submission upon go-live. We protected our revenue stream and helped keep operational performance high. Processing about 80,000 claims per month, our clean-claim rate was 95 percent at go-live and within 30 days climbed to 98 percent. Since go-live, we’ve also been able to analyze patterns and trends as far as potential denials. We’ve seen improved collections and eligibility because we can now check that with every patient who walks through our door.

An EHR build is one of the most daunting and unenviable projects a healthcare organization can undertake. By leveraging a close and collaborative partnership with new and existing vendors we were able to meet our deadline and ensure that our ability to process claims and receive payments continued unabated.