Epic Revenue Cycle Consulting with post implementation workflow analysis is critical to assuring that what was “built” in the “system” is working well. A recent engagement at an academic medical center revealed revenue loss and a higher rate of denials pre and post claims submission. The system as “built” by the hospital staff turned out not to reflect the reality of needed workflows and the creation of workarounds and redoing of work.
In the engagement we found additional staff had to be hired in order to address the claims that could not pass the edits and then the aftermath of claims that were denied. At this client almost 4% of their revenue had been affected negatively.
Health Systems Management Network, Inc. (HSMN) was called in as it has been for over 27 years to put feet on the ground who could sort out the problem areas.
HSMN tackles these scenarios by beginning with a full assessment of where revenue is lost or claims are being rejected based upon clinical data, documentation and coding. We use such data to work closely with the medical staff on a case by case basis to help them see what is required to be successful in the ICD 10 world for both the hospitals and professional fees.
The work for this medical center consisted of the analysis of workflows and their product which were subjected to a “deconstruction” technique that parses the causes for each of the failed claims. Once the parsing is done, the workflow is reconstructed to work so that it reflects the reality of medical staff behaviors and everyone who is part of the revenue cycle. Epic is an amazing and robust system but its implementation which is so much in the hands of operations staff who have to pay attention to their work as well as design workflows is often flawed.
HSMN has worked with the redesign of all workflows, staff behaviors, organizational structure, and skill sets and put them in the appropriate context working closely with the hospital staff. HSMN has been very successful in its Epic revenue cycle consulting and post implementation analysis.
We have found that often “staff” are so emotionally tied to the “workflows” built for the Epic System that they often lose objectivity when it comes to identifying flaws. In the engagements, we listen carefully to staff, observe work at all levels including physician behaviors and then help the internal staff to regain their objectivity and partner in identifying the flows that must be fixed after finding the “root cause” of the problems. We would encourage Epic revenue cycle consulting and post implementation analysis as a positive and results-producing activity that can make a difference in the bottom line.
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