That means optimizing processes and workflows in each of the three major revenue cycle streams — upstream patient engagementmidstream revenue recognition and backstream billing and collection.
Fortunately, if you are an Epic user, you have tools in each of the three streams to help improve your revenue integrity accuracy, efficiency and productivity.
Meeting demands for better patient engagement not only improves satisfaction and increases patient retention, it can also ensure starting the revenue cycle process off on the right foot. Processes properly implemented at this early stage go a long way in improving billing and collection in subsequent revenue cycle streams.
With MyChart and EpicCare, patients can easily populate their information on their own in the less stressful privacy of their home prior to the visit. This will ensure that more accurate information is put into the system. MyChart enables patients to access their test results and visit summaries but it also provides a way for them to check their statements and set up payment plans when necessary.
With this information readily available, front-end staff can confidently request full patient liability payment rather than just the co-pay amount or, worse case, no payment at the time of service.
Epic vs. Cerner: 9 key comparisons
Having this knowledge up front can greatly increase the chances of your getting paid. Epic functionality can make the front-end process a much smoother experience for both the patient and your office staff. Understandably, much of the focus for organizations has been on the front-end patient access process or back end billing and collection operations. Recently, however, there has been a new emphasis on the midstream, the process that begins when the provider signs the encounter and ends when the claim is accepted by the payer.Premier protein shakes
Accuracy is key in the midstream as even a one percent error rate can be worth millions of dollars to an organization depending on its size. There are several Epic features and functions that can ensure the accuracy you need to optimize your mid-cycle stream. This ensures that you will bill patients correctly if they change coverages while a bill is in process. Setting up retroadjudication properly will help you avoid reprocessing charges that may have already been posted and are being sent back into the review process unnecessarily.
Eliminating these false charges into the charge review workqueue will reduce your workload and allow coders to focus on actual charges with real issues. You can fine tune the retroadjudication feature by setting up custom workqueue rules that address specific situations your organization may be facing.
Another way to ensure the efficiency of your midstream is to ensure claim edit workqueue efficiency.
To avoid duplication of effort when dividing the workload, make sure that your billing team groups are approaching their workqueues appropriately.To accurately display the priority, the Referral Priority column must be added within the workqueue itself. Review the impact of these referral workflow improvements on providers in this Quick Reference Guide. Details about required training for Clinic Managers and Referral Coordinators related to the June 14 improvements are available here.
Background information on the Referrals Workgroup and a list of previous improvements to the referrals process is available here.
Workqueue entries should also be worked oldest first within each priority value. Internal vs. View details in this Tip Sheet. Impact on providers Review the impact of these referral workflow improvements on providers in this Quick Reference Guide.
Required Training for clinic managers, referral coordinators Details about required training for Clinic Managers and Referral Coordinators related to the June 14 improvements are available here.
Background on Referrals Workgroup Background information on the Referrals Workgroup and a list of previous improvements to the referrals process is available here. Share This:. Filed under: Epic.Hospitals often love or hate Epic or Cerner and they often defend the choice the system made or complain that their system made the wrong decision. Although the two healthcare IT vendors provide similar services, the two companies function very differently.
They are both based in the Midwest and each serve approximately 30 percent of the hospitals across the nation with more than 1, patient beds. Epic mostly serves large hospitals, while Cerner also owns a comfortable percentage of the market of hospitals with between and beds, according to a survey of hospital executives by research firm peer She lives in Madison, Wis.
She is listed as No. She is a self-made CEO and one of the few women on Forbes' list. She is a graduate of the University of Wisconsin-Madison mathematics program. Patterson is one of three co-founders of Cerner — a company that began with a single lab information system in He worked directly with the company to create a full suite of healthcare applications by the mids and took the company public in A native of Manchester, Okla.
Faulkner, its CEO, has rarely granted interviews until this year. Its website conspicuously lacks a media contact page because the company rarely converses with the public.
Are Your Epic HB Workqueues Broken? Here’s How to Fix Them
View our policies by clicking here. Epic vs. Cerner: 9 key comparisons. To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Reviewsign-up for the free Becker's Hospital Review E-weekly by clicking here.
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Contact Us 1. All Rights Reserved. Interested in linking to or reprinting our content?Workqueues are a cornerstone of Revenue Cycle management in Epic; they can provide powerful functionality to keep business operations running smoothly.
Are Your Epic HB Workqueues Broken? Here’s How to Fix Them
Building anything properly the first time always makes life easier, and building workqueues in Epic is no different. It is much more difficult to correct and clean-up workqueue build once Epic is live than it is to take the initial effort to carefully design, build and test your workflows right at the start. Workqueues should mimic your workflows — Take your workflows and map out a life of an account across your workqueues.
This will ensure the flow from workqueue to workqueue is intuitive and that stakeholders have a workflow to follow. Use claims from your legacy system to reproduce accounts. Use a mix of very common diagnostic imaging, etc. Ensure that every workflow is accounted for in your build. In this situation, you might implement the following workqueues:. Ensure that the criteria for why accounts hit a workqueue and why they fall off is clear and well understood — This must be well-defined for testing and support.
Trainers can use this information as they develop training criteria. Test your build — A reminder to test might sound unnecessary, but when rolling out a new build, testing is crucial.
Make sure that you include negative results testing as well as positive results testing and ensure that your back-end and front-end edits are in-sync. Any revisions you have on claim edit or account workqueues should also be captured on pre-registration and registration workqueues since they are worked and owned by different sets of users. For example, if a claim requires a referring provider, and that piece of information is captured at registration, it should be reflected in both your patient workqueues as well as your claim edit workqueues.
Assign an owner to every workqueue — Accountability is key. IT will own system issues and Operations will own workflow issues.Acms software
Workqueues are the way you support and run Revenue Cycle in Epic and it is critical that the users understand the expectations of what is hitting a workqueue, why and how they correct the issues. Create a plan for end users outlining the different types of workqueues and how to work the errors. When built well, Epic Workqueues can be powerful.
Epic Workqueues and Revenue Cycle
Taking the time to ensure that you have each piece of your workflow scheduling, registration, insurance verification, charging, claims, etc. Impact Insights. Epic Workqueues and Revenue Cycle. Here are a few things to keep in mind as you start your build or look at optimizing workqueues: Workqueues should mimic your workflows — Take your workflows and map out a life of an account across your workqueues.
Please enter all requred fields.Workqueues WQsworklists, spreadsheets, reports. They are all trying to help us answer the same question: What accounts should we work and in what priority? How frequently is your PFS management team asking staff to re-sort their workqueues, work off spreadsheets for special projects, or work through a stack of paper denials?
Workqueue build in Epic is one of the most critical pieces of your install and ongoing maintenance. After all, these are the primary workdrivers for your exception-based workflows.
But are you really working the exceptions? What is my workqueue structure? On the surface, this seems like a simple question. Most of us have been through a workdriver design session where we outline what we need. Typically, the conversation centers around how many staff we have, who has expertise in what areas and what our volumes look like. Workqueue structure is complete. Seems simple right? Did anyone ever stop to ask the question about whether an account should be able to qualify for one or all those workqueues at once?
If a patient has an outstanding balance on their primary insurance bucket due to an underpayment and an outstanding patient balance, the account could conceivably be in three places at once insurance follow-up, variance, and self-pay. Who do I go to on my team to get the account resolved? This is where an effective workqueue waterfall structure comes into play. Understanding how you need to break out your account populations billing, government, commercial, self-pay, denials etc.Theocratic meetings 2019
The overarching goal should be to get as close to a account to worklist ratio as possible with the understanding that there are always exceptions to the rule that are unique to each provider. Do I have transparency? The methodology behind workqueue build tends to slip over time. Issues are identified and workqueues are hastily put into place to house special projects.
Staff and management transition in and out of roles and before you know it, your six months post live and your workqueues are out of date. The problem only grows over time. This includes descriptions, owners, supervisors, and groupers. Additionally, while workqueues do require a name, they do not require a consistent naming convention.
Name — To help drive reporting transparency, similar workqueues should have similar naming conventions. When developing workqueue reporting, this will help ensure like populations are grouped accordingly. Description — When a workqueue is three years old and the people who built it and worked it have long since departed, this is the best way to understand how and why this workqueue is in place. It is also critical for new hires that are starting to get their heads around their new workdrivers.
A good description outlines the purpose of the workqueue, broad scope of what is included, and any specific carve outs. If WQ scoring is in place, the description should also provide an overview of high priority scoring logic.Cell structure and function worksheet answers
Owner — Who is the primary resource responsible for working the account populations?On one hand, it centralizes information and opens communication across the provider spectrum.
On the other hand, many supposed efficiency gains are bogged down in tedious workflows while promised reporting transparency remains unavailable or hidden in a mountain of reporting options which may all yield different results. Five examples of underutilized Epic functionality that revenue cycle leadership should evaluate include account prioritization also known as workqueue scoringactivity code enhancement, simple visit coding SVCwatch list development, and comprehensive workqueue re-design.
Some of these concepts can be designed and implemented as part of an Epic installation while others are ideal for clients that have been live for a period. A buzz phrase within the Epic community, workqueue scoring allows for the development of customized logic to prioritize accounts within a workqueue and group account populations into categories i. In addition to financial and productivity benefits, workqueue scoring can also help empower operational leadership to drive accountability by improving transparency around workqueue performance.
Leadership can provide feedback or triage staff based on the high priority volumes within each workqueue. This helps to ensure that all high priority accounts are worked within a timely manner, reducing financial risk to the provider. The flexibility of workqueue scoring should empower leadership to improve financial performance while remaining flexible enough to target special projects and evolve as the business office book of business changes over time.
It is recommended that workqueue scoring be implemented in a limited fashion prior to go-live when possible and evolve over time as the AR continues to build and change. For those providers who are already live within Epic, a comprehensive workqueue scoring approach should be reviewed and implemented across all areas of the revenue cycle.
Activity codes also known as billing activities in Epic are a frequently underutilized tool. They can be used to drive system automation, increase productivity, improve interdepartmental communication, and help drive reporting around staff quality. While Epic comes pre-populated with many different activity codes, often, they are not built out to adequately improve workflows and improve staff productivity.
Activity codes can be used to automate things such as outsourcing and insourcing accounts, account escalation, routing between departments, sending letters, and standardizing documentation. These scores can help drive productivity reporting within Epic to help understand how effective staff are in their account touches. Effective activity code build within Epic should be an opportunity to improve staff productivity, while also driving consistency and improving communication.
Activity code development can also drive quality metric reporting for management to better understand staff performance and drive improvement. Activity codes should be developed prior to go-live when possible and evaluated on a quarterly basis to ensure that they support existing revenue cycle workflows.
Simple visit coding is a frequently neglected, or only partially developed functionality within Epic. The end goal being for staff to work accounts on an exception basis. Simple Visit Coding leverages the diagnosis information combined with a late charge analysis to identify those populations of accounts that would be eligible for Simple Visit Coding. Additionally, increased automation through simple visit coding can lead to staffing flexibility and efficiency gains. It is recommended that simple visit coding be combined with flexible MinDays suspense daysallowing for claims to be sent earlier and the payments received faster.
Simple visit coding should be implemented in a post-live environment once staff have become comfortable with workflows in Epic including charge entry, diagnoses documentation, and coding workflows.
While the Watch List has improved over time, it remains one of the most powerful, yet underutilized tools within Epic. Additionally, the dashboard includes drill-down functionality for root cause analysis and special projects.
Development of customized metrics can provide invaluable insight into the health of the revenue cycle and can drive cash improvement and reduce denials. Watch List metrics can be implemented at any time pre or post live. Metrics may need to be refined over time as system logic evolves and can be created and deactivated for special projects as necessary.
Finally, metrics can be customized to specific owning areas such as No Response, Billing, Denials, etc. Workqueue re-design is a comprehensive assessment of existing workqueue logic and functionality across the revenue cycle. Frequently, for clients who have been live on Epic for several years, the volume of workqueues required to be monitored by staff can increase to a point where it becomes difficult to manage. Workqueues are neglected, ownership is not updated, descriptions are out of date, or the logic is not comprehensive to catch or eliminate specific account populations.
Conversely, numerous staff may work out of a single workqueue utilizing Epic filters, which creates difficulty in driving staff accountability. Workqueue re-design evaluates existing workqueue logic to find black holes or workqueue logic overlap, as well as delinquent workqueues that are not actively worked with an end goal of reducing the number of workqueues within the system and working to get closer to a single workqueue per staff member.This pertains to handling people waiting in turn for service.
Lines, waiting rooms, waiting lists, anything like that is under scrutiny by this science. But, it also goes a step further to managing waiting work orders to resolve problems or investigate them as well. But, part of it is.Epic Certification Training: Four Common Questions
In modern times, we see different wait structure, often less defined from the view of the customer. In most cases, it simply tells the user that the request for help has been tendered, and will receive a response as soon as possible. On the underside of that, tickets tend to be prioritized by urgency and time submitted. Most support and service teams running over these frameworks will have the goal of clearing the queue of urgent ones in the order they were received, and then divide up piles of the lesser in order received among each other, to see that in the gap, all other levels are touched while urgent are addressed ASAP at all times.
A lot of bad unanimous decisions by businesses at large have led to the call center being a bad experience. But, once automated menus replaced operators, and then computers tried to be CRM agents themselves over voice recognition happened, things got bad.
On top of that, the outsourcing has resulted in mismanagement of staff allocation to handle incoming volume. And the customer, of course, is the one who suffers for this corner cutting. In order to handle queues better here, there are just some common sense actions to take, and beyond that, it is what it is. Simplifying the menus, and never making them more than two button presses deep is very helpful.
Making it possible to dial out and get a general agent is a must. During wait times, looping music must be of high sound quality, and the loop very long. It needs to be relaxing and globally inoffensive, and classical is a good choice for that. Intermittent advert recordings are a no-no. Skip to content. This works, and nothing can be done to further it beyond staff growth.
Call Centers: A lot of bad unanimous decisions by businesses at large have led to the call center being a bad experience. Hold times should never be longer than five minutes. If they are, that is not okay.
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