The following is a guest blog post by Kerry Harbeck, Director of Learning Innovation, and Andrea Kamper is the Innovations Operations Manager for Breakaway Adoption Solutions at Atos.
Electronic health records have evolved. Modern EHR systems now provide full revenue cycle management for healthcare organizations, in addition to traditional clinical record-keeping functionalities. As with anything new, large, and complex, there are natural aches and pains. Our clients have lost revenue when they switched to new EHR-based patient accounting applications, with some organizations experiencing losses in the $30-50M range. There are several reasons for these losses, including billing errors, IT infrastructure problems, lack of financial policies, and untrained staff.
As we started to look for a solution to prevent such revenue losses, it seemed natural that improved patient accounting education was part of the solution. However, our research showed otherwise. After several go-lives, multiple meetings, countless emails, and many interviews and onsite visits, we concluded that the problems didn’t stem from the billers’ knowledge of the new system. In fact, billers were typically spending much of their time fixing errors created upstream by different roles within the organization.
Here are the 3 major hot spots we found that cause billing failures:
- Lack of organizational awareness and role-based understanding of the organization’s clinically-driven revenue cycle management EHR.
- Patient access staff originates the patient’s EHR, thereby beginning billing and charting process. Often, people in this role do not understand their significant impact on the success of a patient’s bill and a clean claim.
- Clinicians and providers do not understand how their EHR workflows impact revenue. These workflows impact the average organization to the tune of one million dollars per year.
- All end users need education which introduces how each role plays a unique part in the clinically-driven revenue cycle workflows. When people see how their work either positively or negatively impacts their colleagues, they naturally become more motivated to do the task correctly.
- Patient Access staff need education regarding customer service, insurance, financial policy, and money handling in addition to their role-based EHR training.
- Clinical and provider roles need education regarding how they individually impact the billing process according to their organization’s best practices and policies.
- Billers and HIM staff need targeted learning focused on queue-based workflows, and how to troubleshoot issues that may have been caused upstream by their colleagues.
- All roles benefit from a day-in-the-life perspective that shows when and where their tasks impact a clean claim.
We know if we cannot measure something, we cannot not manage it. Our recommendation focuses on the following performance metrics:
- KPIs: Organizations need to determine which key performance indicators must be tracked to allow them to meet their clinical and financial objectives. From a clinical perspective, list objectives for both acute and ambulatory. Do the same from a financial perspective. Create timelines for tracking objectives and utilize technology to store and analyze the data.
- Leadership engagement is a key element to a successful EHR adoption, and a healthcare organization cannot be successful without an organizational change management strategy. Staff need to understand why change is happening, how the change affects their workflows, how to get ready for change, and what education and mandatory requirements must be completed prior to using the clinically-driven revenue cycle EHR. Tracking leadership engagement identifies whether communication is effective or needs a new approach.
- Proficiency allows a staff member to use the EHR according to the organization’s rev cycle best practices workflows that are critical to that role. Create a proficiency threshold for all roles and make education mandatory.
- Workflows need to be optimized to continue the adoption journey. When new changes affect end-user workflows, update the education to allow new and existing employees to become competent in the optimized workflows.
To create a learning and performance solution for your healthcare organization to teach revenue cycle workflows, begin by taking the following actions:
- Determine key roles and critical workflows that impact a clean claim
- Understand how the roles work together to generate a clean claim
- Determine what KPIs should be targeted
- Create a mandatory education program that is role-based
- Use technology to track end-user training compliance and competency
- Maintain education materials for both existing and new employees
About the Authors
Kerry Harbeck is the Director of Learning Innovation for Breakaway Adoption Solutions, Atos
Andrea Kamper is the Innovations Operations Manager for Breakaway Adoption Solutions, Atos
About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.