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Does the Billing Department Play a Role in EMR Implementation?

October 21, 2013

Short answer, most definitely.  The benefits of EMR are not fully realized
when it is used for clinical purposes only and is not interfaced with the billing system. Representation by the billing department in EMR implementation is just as critical as clinical involvement. While each have a very different area of focus and expertise, one is very dependent on the other.

How does billing know what to bill?  The clinician selects the codes based on the
visit and associated documentation.  Once EMR is implemented, the codes are output from the EMR to the practice management system (PM), typically via interface.  Setup and configuration of the EMR to suit clinical needs does not necessarily equate to maximum efficiency realized on the billing side when these departments are not equally involved.  Clinically, there may be some requirements to accommodate workflow for different types of visits/services.  On paper, billing can apply rules and logic to accommodate what they payer is expecting to receive for those same visits/services.  How much efficiency is achieved when billing must ‘touch’ every encounter to modify what is being output from the EMR? Collaboration will provide an opportunity for each to present their desires and needs while also gaining a better understanding of how the other side is impacted and together, determine the best course of action.

Implementing an EMR can be a daunting task.  There has been such a heavy reliance on the physical chart for so many years. How many of us cannot recall a time when we had to search high and low for a patient’s chart and ‘out’ guides that didn’t really indicate who had it or why?  Those days are going away.  With EMR, everything is at your fingertips – why was the patient here?  Who did they see?  What happened during the visit?  Immediate access to clinical data is beneficial to billing departments as well. They live in the PM but may find themselves having to consult the chart to resolve a billing issue or to appeal a claim.  Billers do not need to be EMR experts nor do clinicians need to be billing experts yet each plays a very important role in the revenue cycle.  Billers should have a working knowledge of the EMR workflow to assist in identifying possible solutions effecting claim submission/payment. Having an avenue in which both departments provide input regarding configuration of new systems can benefit the organization as a whole, during implementation and beyond go-live for increased output of clean claims; decreased manual intervention whenever possible; challenges are identified and addressed immediately; payment timelines are decreased; etc.

The impact of EMR is most immediate on clinical operations. In an effort to diminish the impact on billing operations, get them involved as early as possible.  EMR implementation should be a staged, gradual and controlled process with defined roles/responsibilities and expectations for all involved.  Rolling this out based on department/specialty, clinic site, provider and/or a combination of all three will afford a better opportunity for all areas of the organization to monitor progress, ensure compliance and achieve maximum efficiency.

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