Health care is often reactive rather than proactive when it comes to improvement opportunities. It is often a race to fix what went wrong, not to establish infrastructure to prevent it.
Related to the above is the fact that EMR / EHR is a significant outlay of cash for providers of something that is not directly a medical product. EMR / EHR does not treat patients, but this is often something that is more easily interpreted as administrative, since many medical offices focus only on earning dollars.
EMR / EHR companies use every angle they can to make their product stand out from the others. Some EHR / EMR vendors include billing software and tell providers that their EMR “software” also does billing. They also press that EMR and billing are “linked” to each other. They tell their prospects that they can save money by not hiring a billing service to take care of billing and collections (Revenue Cycle Management), but anyone who is an expert in RCM knows that this just isn’t true.
Personally, I see EMR as a completely separate entity from billing. Having billing software doesn’t mean it’s smarter for a provider to keep billing in-house. In fact, most providers outsourcing their medical billing already have billable software. The issue for most providers that choose to outsource is that they realize that they need to maximize their reimbursement at every turn, and they do not have experienced staff who expertly and consistently handle billing, claims tracking, phone calls, refusals and appeals process , keep abreast of the ongoing changes in the health care mandate, clearinghouse and electronic submissions, credentials and they recognize that the experience they gain from outsourcing their billing and collections to a billing company is critical to keeping the doors open. Many providers are aware that they save money by outsourcing. Some have difficulty hiring, educating and keeping a knowledgeable person in this position in their office.
No matter how good your billing software is, it is only as good as the one using it. A provider’s income is dependent on billing. If they do not, they will lose money no matter how good their software is and whether it is tied to their EMR / EHR.
Having key features within your EMR / EHR and Practice Management solution can help the transition to go more efficiently and bring you some savings.
1. Implementation – cannot be stressed enough. KNOW your needs and desires when choosing your EMR / PM solution. An EMR / EHR should enable physician practice to achieve greater patient efficiency by streamlining daily operations, enhancing the patient-physician experience and improving patient quality.
2. Leadership Engagement – That said, you need to have providers and staff on board for a successful transition. Maybe that means having a small but focused project team made up of “system thinkers” – these are people who understand how the current organization works, but more importantly, have the vision of how it could work.
3. Robust software that emphasizes practice specifications – Define which billing data that practice would like to collect and which is specific to your practice and / or specialty. Does EMR convert meetings / super bills into receivables? “Interface” with the practice management software? If not, the process will certainly increase the time and cost of practice. The correct claim application, taxes and claims discounts must be applied to this feature (critical to ophthalmologist and optometry).
4. Real-time electronic eligibility and electronic claim filing – These features must be provided in any EMR / EPR. Is the software capable of verifying patient eligibility in real time? Will the clearing house provide direct claims control?
5. Robust accounting and financial reports – Report management is important for all billing functions in an ECHR / EPR
6. Electronic Tracking of Payments – All details must be tracked in the payment process. Features should include the ability to log and communicate any action taken to get a claim paid.
7. Real-time Rejection Rejection Analysis – Error codes must be clearly displayed. This feature can enable users to: immediately resolve problematic claims, analyze claims rejection reasons, and provide practices with the ability to monitor red flags as they arise, and implement types of audits.
8. Billing codes deducted directly from the EMR / EHR – This automatic feature includes subtracting (interface) E / M codes and procedures directly from the EMR / EHR documentation. By dragging patient data as it is entered into the patient history, medical notes, pathology and x-ray entries, procedures and prescriptions, services provided are recorded instantly.
Built-in meaningful use dashboard helps providers track progress toward fulfilling meaningful use certification.
9. Multi-user, secure and user-friendly – Users need to be able to use powerful embed claims management solutions, claim status technology that automatically checks claim status to improve reimbursement, automatic application submissions to name a few.
10. Monitoring, Backup and Data Recovery – Prevention is always the best measure and a system must be firmly in place for system monitoring and backup.