Revenue Integrity
As an integrated network of 21 hospitals, more than 40 outpatient health centers, and 200 physician offices is implementing Epic, Impact Advisors provided revenue cycle and clinical operational engagement expertise to help prepare the organization for the coming changes. Specific focus was given to charge reconciliation. Before the engagement, there were inconsistent or non-existent charge reconciliation processes across hospital departments and clinics, charge reconciliation efforts were not actively monitored, and there was a general lack of engagement among the departments. The client sought assistance with adopting standardized charge reconciliation processes, and leadership chose decentralization as the method to achieve it.
Approach
Impact Advisors assigned an Operational Engagement Revenue Integrity Partner and team, who supported the organization’s Director & Manager of Revenue Integrity throughout the implementation from pre-planning to post-go-live support.
Prior to go-live, the Operational Engagement consultant developed a detailed change management plan outlining key steps, timelines, and potential risks to mitigate when implementing decentralized charge reconciliation. Working hand-in-hand with the Revenue Integrity Team, Epic ARCR (Access and Revenue Cycle Readiness) partners, and the Training Team, they:
- Identified who from each of the 2,500+ departments would be owning/performing charge reconciliation and ensured over 900+ end users were signed up for training.
- Developed workshops to review expectations with the identified charge reconciliation owners to help them understand their role, including how to set up and utilize reports in Epic to
monitor charging for their department. - Validated cost center/work queue owners and baseline expectations.
At go-live, Impact Advisors worked with the Revenue Integrity Team and Epic ARCR partners to monitor dashboards and track KPIs. They also investigated potential missing charges and system issues. To help ensure sustainability, the team facilitated and attended:
- Weekly revenue tracking meetings with each clinical area until each area stabilized. A revenue tracker monitors revenue by service line, cost center, etc. to
make sure all charges are captured at go-live. - “Office hours” for charge reconciliation owners to bring questions regarding reports and to catch and reconcile issues. For example, if revenue was low, the group helped owners identify why, follow up on and investigate encounters with missing charges, and gauge provider comfort regarding charging.
Overcoming Challenges
Getting clinical and department staff to understand the importance of charge reconciliation presented a hurdle. In Epic, charges will not post (or count towards RVUs, or
Relative Value Units) until the billing encounter is closed, signed, immunization marked as administered, etc. and until all charge review errors have been resolved.
Results
By three months post go-live, the organization had surpassed its target, increasing charge capture in Professional Billing to 8% above baseline gross revenue
and in Hospital Billing to 3% above legacy baseline gross revenue. Other outcomes included:
- Financial stability and a consistent revenue stream.
- Early identification and resolution of root cause issues with charge workflows, documentation completion, charge entry, and CDM setup.
- Increased collaboration and accountability with clinical teams by service line.
- Revenue guardian checks, high dollar, high quantity, and service date out of range charge review edits worked and monitored by each cost center ensuring
resolution at the source to mitigate avoidable errors. - Revenue Integrity provides overall monitoring and is a resource for when further review is necessary and works other account and charge review workqueues.
“I would highly recommend Impact Advisors to anybody. They were a true partner through our engagement. Their consultants brought so much expertise, passion, and direction. They were one of the best partners I have worked with. Impact Advisors went above and beyond to try to support us, even when it came to their time and commitment. They were available. They worked so hard and were available around the clock to assist us and assure us that our project was moving forward. I haven’t worked with another firm that has always been willing to jump in and help wherever needed.”