6 Considerations When Preparing for EHR Billing Cycle Support

When assessing go-live support for an electronic health record (EHR) implementation, there are several factors to take into consideration. Clinical EHR go-live support models tend to go 2-3 weeks while the EHR billing cycle takes far longer to touch all aspects of the system. The EHR billing cycle will span several months to cover all aspects from start to finish. An EHR billing cycle can be broken down into these three distinct areas:

1. Claims
2. Recoupment
3. Customer Service

When planning for EHR billing support, these questions should be considered.

• Is this a Single Billing Office (SBO)? If the answer is yes, all billing functions occur primarily in one location. If the billing office is decentralized and professional and hospital billing is not done in the same place, this may affect your strategy.
• How many days post-discharge will a claim be generated? Professional billing will generate claims once the encounter is closed. Typically this is a daily occurrence, and as such, professional billing will begin generating claims on day two of the go-live. Hospital billing typically has a 3-10 day hold on accounts, generally referred to as min days. This allows charges to be added to an account and any other pertinent information to be obtained before generating a claim. That doesn’t mean there won’t be work for the billing staff. There will be less volume until the min days are met. Billers will have pre-claim edits to work for registration type errors and such until the claims are generated at the end of the min days. The work will then steadily ramp up for claims.
• Claims structure – How does the organization structure claims? Is it by payor, commercial, government, etc.? Many organizations will have separate departments working on different types of claims, and this may entail specific information or processes that will need to be understood and followed for each department.
• Outsourcing – What services are outsourced to vendors? Many health systems outsource things such as motor vehicle accident accounts (MVA), third-party liability accounts (TPL), past-due accounts, etc. This is crucial to understand when planning billing support.
• Recoupment – How are Insurance and patient payments being processed? The answers to this question will help to identify the amount of detail the support person will need to know when working with this group.
• Customer Service – Do they have an onsite customer service staff? If so, are they dedicated to specific types of accounts? Customer Service is one of the most challenging areas to staff for go-lives. This is a fast-paced area that generally deals with a multitude of scenarios. The staff must be very well versed on where to find information quickly. Also, this group typically doesn’t engage until after the first statement processing has gone out to patients, so this is an area to find out at what point they will be engaging and make sure there is adequate support.

It is tough to know all aspects of the EHR billing cycle in-depth. Invest time in making sure end-users and support have the workflow specific information. Not all organizations function the same, and there are some very specific workflows developed for the billing cycle. Take the time to share workflow diagrams and educate the end-users and support on these specifics to lessen the chance for errors during EHR implementation and go-live.

As you plan for support, remember that the EHR billing cycle is like a wave. It will ramp up then down in each area. Maximize on this and shift the support as one area is decreasing in need to the next area that will be ramping up. Your support will be well versed with the issues from the beginning of the process and will be better able to assist in troubleshooting the problems later on in the billing cycle.

Many other factors will play into the number and duration of support necessary to make the EHR billing cycle implementation successful. These are only a few high-level considerations.