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Utilizing Your EHR to Full Capacity: Your RCM System, ICD-10 & Meaningful Use

January 5, 2016

EHR_full_capacity.jpgHoping to encourage health care organizations to move toward health information technology (HIT) and electronic health record (EHR) adoption faster, the federal government allocated more than $14.5 billion dollars in Meaningful Use incentives in the 2009 stimulus. On the surface, adoption numbers seem to suggest the stimulus was successful. Today, four out of five hospitals utilize EHRs, and almost as many office-based physicians (78%) have adopted some form of EHR system, according to 2013 stats released by the Centers for Disease Control & Prevention (CDC). However, transforming the healthcare industry is more complicated than simply improving adoption rates.

Health Information Exchange (HIE), Self-Pay & Value-Based Reimbursement

Medical providers want to improve quality of care and reduce operating costs. Simultaneously achieving both is at best challenging in the changing landscape. There are many external factors that influence patient services quality and financial health today that medical organizations must consider, burdensome government mandates, patient-consumer expectations and new technology that often comes with a steep learning curve are just three. Just when EHR adoption is improving, along comes the push to get all medical providers on board with HIE. As the industry moves closer to an accountable care model, with lower reimbursement rates and higher percentages of self-pay patients, the number of physicians who are embracing HIE continues to grow. In a 2013 interview with Healthcare IT News, Brendan FitzGerald, HIMSS Analytics Research Director said nearly 50% of respondents to their most recent Ambulatory Electronic Health Record & Practice Management Study planned to invest in HIE and more than a third, some 35%, of responding physicians had plans to buy or upgrade EHR systems. More recent studies suggest between 25% and 35% of providers aren’t happy with their current technology.

Utilizing Your EHR to Full Capacity

One of the key takeaways from a Software Advise survey exploring the impact of the HITECH Act on EHR Implementation is that providers and medical institutions must intentionally compare software and technology, and the vendor suppling the solutions, before buying a new system. An ideal EHR has built-in capacities to help independent physicians and group practices capture more revenue, improve productivity and enhance patient satisfaction if used properly.

Minimally, EHR systems will support electronic communication that enables faster diagnostics and peer collaboration/consultation, alerts appropriate staff when a patient visits, or interacts, with another provider or medical facility, e-prescribing and both internal and external communication with staff, providers and patients.

Assessing practice workflow is essential to effectively managing the revenue cycle. Analytics within the EHR enable administrators to identify inefficiencies in the front end processes and policies to improve patient flow and modify staff schedules.

Physicians can apply RCM best-practices that include streamlining front end tasks with automation whenever possible.

  • Verify insurance coverage and co-pay prior to appointments.

  • Utilize patient portals to send appointment reminders along with automated telephone and text messages.

  • Leverage internal features that help reduce denials, such as KPI reports, queries to identify duplicate charges and ICD-10 coding support tools.

  • Consider implementing a program that gives patients the option of pre-approving credit card charges once claims are adjudicated.

  • Exploring outsourcing billing & coding tasks.

Outsourcing for Higher Profit Margins

Although it may sound illogical, outsourcing billing and coding tasks to a reputable vendor could cost less than hiring and training full-time staff members to assume the role as billing specialists. An MGMA study completed in 2013 revealed almost 75% of responding medical providers realized higher collections values and almost six in ten saw their denial numbers fall. The best way to discover if outsourcing is right for your medical enterprise is to complete a thorough revenue cycle audit that includes a cost per transaction analysis. Before contracting with a billing and coding firm, have a discussion with your representative about the role your EHR plays in claims processing and collections.

It is becoming increasingly more difficult for physicians to provide high-quality patient services while remaining financially solvent. Utilizing your EHR to meet Meaningful Use quality reporting mandates, expedite claims processing, reduce denial rates and streamline office efficiency, positions practices to improve revenue potential and patient experiences.


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