Driving Revenue Cycle Success with the Right EHR

By Sreeram Mantha, Partner & Chief Operating Officer, iHealth Innovations
Twitter: @RevenueSherpa

With the federal meaningful use program having dangled the “carrot” of millions of incentive dollars in front of healthcare providers to implement certified electronic health records (EHRs) over the last decade, many more systems have been implemented than ever before. What was a “nice-to-have” on the cutting edge of practicing medicine in the ’90s or even 2000s has pretty much become a “must have” for all but the smallest practices today. The latest-generation EHRs with an integrated practice management (PM) component can be invaluable to the success of your revenue cycle process efficiency, cash flow and profitability.

However, the wrong EHR/PM — or one that’s been poorly implemented or used — can have the opposite effect…to slow down or even reduce the reimbursements you should rightly be collecting.

Especially now, when early EHR adopters are learning from their original choices and mistakes and are evaluating their second or even third EHR, it’s an appropriate time to look at what technical and operational capabilities these systems should include to optimize your revenue-cycle success as we accelerate towards value-based care.

The iHealth team has worked with virtually all EHR vendors over the years and will continue to do so. But the experience has taught us a few things that — if you select a system that includes (and you correctly use) these features — can go a long way toward empowering a revenue-cycle partner such as us to speed cash flow and maximize reimbursements…so you can not only survive but thrive.

Basic capabilities of today’s EHRs
An EHR/PM can be the driving engine that support the most effective and efficient healthcare delivery possible. That includes not only its clinical record to drive care but its PM functions (primarily admission or scheduling/discharge/transfer demographic data, or ADT) that gather all the information needed to drive your all-important coding, billing and collections functions. In today’s technological world, some of the EHR’s fundamental requirements and capabilities should include:

  • Constructed as a single system on a common, standards-based platform
  • Broad standard medical terminology, including different terms used by different providers that mean the same thing, while mapping to the correct billing code
  • Ability to seamlessly interoperate with payers’ systems for moving patient eligibility checking to the front end of the care interaction, not the back end.
  • Support patient check-in devices (tablets, kiosks) and an intuitive patient portal to streamline administrative processes and encourage patient-friendly engagement.
  • Share discrete data among the patient’s authorized providers, regardless of the information systems they use or which organization they are affiliated with.
  • Both clinical and financial synchronous (real-time) and asynchronous alerts both while care is being ordered — alerts that leverage authorization and pre-certification as well as evidence-based care — and delivered as well as when abnormal lab results are returned or a test or procedure is ordered that falls outside of the patient’s insurance coverage or clinical best practices and standard outcomes.
  • An intuitive, fast and easy-to-use interface and workflows that can be customized by specialty, organization or facility…even down to even the individual provider level.

Revenue-cycle benefits
There are certainly many other important features that the best of today’s EHRs should have to meet the challenges of today and tomorrow. Hopefully the revenue-cycle benefits of most of these seem obvious and intuitive, but to recap some of them briefly:

  1. ​Systems that talk to each other. Systems based on the latest generally accepted interoperability standards, such as HL7 and FHIR (pronounced “fire”) most seamlessly share data back and forth between their own and other providers’ and payers’ EHR/PM and RCM systems. This not only contributes to coordinated care and reduces unnecessary — and uncompensated — duplication of services, but helps ensure a more complete and cleaner claim when it’s submitted for payment. As most providers and RCM services providers know, it’s not that difficult to get the first 80 to 85 or even 90 percent of what should be your appropriate reimbursement. But without the right clinical and administrative/financial documentation, along with alerts to trigger staff to perform follow-up, that last 10 or more percent of collections can be considered too much of a bother and is just written off by many providers…often wiping out their profit margin.
    ​This electronic “data liquidity” further improves the accuracy and completeness of the superbill. Think of a physician treating patients in hospitals using disparate EHRs. Too often, the doctor carries a paper superbill which typically is later retyped by a staff member into the office system in hopes of (A) getting paid and (B) maintaining as complete a patient record as possible. That’s both a waste of resources, and provides another touch point with the data where human errors can occur.
  2. Making it easy to pay. Patient check-in pads or kiosks are a way to improve the patient experience while also weaving in a “soft collection” or low-threat way to receive estimated patient deductibles and co-pays up front. The patient’s percentage of out-of-pocket costs continues to rise and studies show that half of the patient’s portion of the bill is never collected if not received at the time of service, which has a growing impact on provider revenues.
  3. Reducing denials. Many systems are still lacking in denial management or denial remediation capabilities. Or the provider organization hasn’t taken the time to fine-tune the system to meet their unique needs, or staff may not have been adequately trained on how to use these tools. At iHealth, we often use our denial-remediation platform tools to analyze data and detect trends — regardless of the EHR/PM system being used — and then follow up with the payers and/or patients as necessary.

Tighter interoperability through innovations
Obviously, you can see that the tight integration of the EHR(s) and other systems used by providers regardless of care venue — what is called interoperability — is essential to connecting care, coding appropriately, maximizing collections and, indeed, improving virtually all processes throughout a provider organization.

The all-important foundation of technology integration admittedly still has a ways to go. HL7 has been around a long time for building interfaces, though FHIR and other emerging technologies are showing even greater promise to helping deliver — and getting paid for delivering — value-based care as defined by Medicare and other payers. And blockchain — a decentralized and distributed technology that facilitates secure online transactions across many computers — may have great promise to provide a single unique identifier that enables secure sharing of a patient’s healthcare data from all of a patient’s authorized providers without individual consent forms or even potentially separate patient portals. This could lead to a truly patient-centered health record. Think of what that would do to improving efficiency, cutting costs and maximizing reimbursement as we solve the “Holy Grail” of interoperability!

The interwoven healthcare and health IT industries have come an incredibly long way in a relatively short period of time, tying together the many moving parts of the industry, but we are still at the forefront of change. Know that we at iHealth are exploring and adopting new technologies and best-practice processes daily, and are excited to be helping you navigate your challenges today, as well as those of tomorrow.

To learn more, see iHealth Innovations’ download Navigating the MACRA Manifesto.

This article was originally published on iHealth Innovations and is republished here with permission.