EHR Replacement: Focus On The Process

By Amanda Griffith, Contributing Writer

Replacing your EHR can be a scary proposition. You can simplify the process by considering your revenue cycle management tools when planning and implementing.

Many physicians’ offices and hospitals struggle with legacy EHRs that lack the improved functionality of their more technologically advanced iterations. Most of these legacy systems don’t integrate well with third-party applications, and many are built as silos not capable of communicating with other systems.

Ripping and replacing these legacy EHRs is one of the most daunting projects a healthcare organization can undertake, and, as a result, it’s natural to place considerable focus on clinical functionality. However, the line between clinical and financial data isn’t as fine as it once was, and a significant indicator of a successful go-live is a provider’s ability to effectively manage payments and claims.

RCM Focus Puts EHR Implementation In Perspective
Baltimore-based Mercy Medical Center and Mercy Health Services, which operates in nearly 100 locations with 50 different specialties, began its implementation of the Epic EHR in July 2012 with the goal of being ready to attest for Meaningful Use (MU) 10 months later. This aggressive timeline — combined with the expense, complexity, and number of stakeholders involved — could have been a recipe for disaster, and Mercy knew it couldn’t afford to make a mistake without risking a huge hit to accounts receivables and cash flow, let alone physician and patient satisfaction.

“In 1999, as a small organization, we purchased what was at the time one of the top physician billing systems for a group of our size,” recalls Fred Morgan, Senior Director of Physician Patient Accounting, Mercy Health Services. “However, over the years, we found our needs and growth far outpaced the technology’s capabilities. Once MU entered the picture, we grew concerned with our inability to attest and take advantage of the financial incentives being offered as part of the program.”

Morgan and his team knew implementing the EHR would be challenging, but he also believed that, by focusing on revenue cycle management (RCM), he could monitor performance throughout the transition. “By focusing on RCM early on,” Morgan says, “we could establish a performance baseline for claims and revenue management, as well as ensure Mercy could seamlessly administer payments and claims while maintaining our financial performance during the transition to the new system.

“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 RCM partner can make a huge difference.”

It also became critical to look at other technologies that would integrate into the system at the same time that would look seamless to the end user and not impact compliance or usability. What made Mercy’s strategy work, in large part, was having a long and proven partnership with its RCM partner, Availity.

“Availity helped us avoid common mistakes and stay focused on detailed integration points and workflows for submission of claims, electronic attachments, converting paper claims, eligibility, remittances, and payment auto-posting,” says Morgan. “Because we already used the company for claims, eligibility, and remittances, we were confident our vendor could help make the transition and integration as smooth and seamless as possible.”

Planning Pays Off — Collections And Eligibility Improve
Mercy realized tremendous success with claims submission upon go-live with its new EHR, including the protection of its revenue stream and help keeping operational performance high. When the company received notification of the project, Availity’s client service team immediately engaged in planning with the Mercy and Epic implementation team. While Epic provided the overarching model and measures that would guide the team through go-live, the Availity team focused on detailed integration points and workflows for submission of claims, electronic attachments, converting paper claims, eligibility, remittances, payment auto-posting, and creating the Epic Claim Reconciliation Database (CRD) workflow outlines.

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.

“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,” says Morgan. “Since go-live, we’ve also been able to analyze patterns and trends as far as potential denials. We’ve also seen improved collections and eligibility because we can now check that with every patient who walks through our door.

“Without the Availity team running multiple testing iterations [and] our client account manager being there by our side — running reports as needed and providing training — our golive experience with claims submissions could have easily gone the other way.”

In hindsight, Morgan concedes that Mercy initially implemented a vanilla system when it comes to workflow. Now, however, he is trying to add some true meaning into how the system can work best for his organization while helping providers reach a new comfort level where they can begin to explore how the system can best work for them in terms of maximizing results.

“At go-live, we were just happy to complete our install within the 10-month window and wanted to be as comfortable as possible in entering charges into the system and getting claims out the door,” said Morgan. “Now we can work smarter and maximize the capabilities at our fingertips.”

Today, Morgan and his team are much more knowledgeable about what true integration really means and have a better understanding of what the technologies can do for Mercy as an organization. Now they can turn to truly optimizing the systems they have, thanks to the partnerships and resources they worked so hard to put in place.

“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,” stressed Morgan. “Not only did our vendor help us get acclimated during our transition, but they also provided guidance, ensured accountability, and helped establish claim benchmarks in a way that our work-queue configurations would help us mitigate missing or lost claims.”

More To Come, Including The Reduction Of Denial Rates
In the future, Morgan and his team plan to work closely with Mercy’s technology vendors to take a critical look at output coming out of their system to see what’s gotten through any safety nets within its EHR. Morgan and his team are also now focused on how to further reduce denial rates, currently at 10 to 15 percent. Morgan would like to see that number in the single digits.

“Tangibly, we’ve seen our AR [accounts receivable] days drop from 50 days in the beginning to 34 days at the end of the fiscal year in June,” remarked Morgan. “We’ve already seen improvements in how timely charges are entered, and we can better utilize the system to manage denials through improved workflows and greater efficiency. We have work to do to get to where top-performing Epic clients are — high 20s — but we know we will get there.”