Like any major IT system implementation, an EHR-EMR migration can be seriously disruptive to hospital operations - and finances. In addition to the many technical and clinical considerations of these projects, hospitals and health systems typically face an array of revenue cycle implications that may pose significant financial risks.

Most of the pitfalls, however, are entirely avoidable, and those providers who align the technical, clinical and financial elements of the project from the start can convert a monumental challenge into an opportunity for improvement.

During many EMR migrations, healthcare finance departments often experience increases in accounts receivable days and claim denials, along with a dip in cash flow. By identifying and addressing potential revenue cycle issues prior to implementation and as part of the EMR workflow, hospitals can stay on track and maintain positive financial performance during the transition.

Retain Revenue Cycle Functions That Have Value

Best Practices for Hospital Electronic Medical Record Migrations QuoteSuch complex, multi-phased projects often present opportunities to introduce new systems and technologies outside of the EMR system, including revenue cycle management. But what may appear to be an upgrade to a system that is better matched to the new EMR isn't always that. This is where the “Ripple Effect” comes into play. The rationale is that the transition presents an ideal opportunity to more fully exploit the new EMR's additional functionality, which typically includes many more features than the old system.

What many providers don't realize is that such “rip and replace” strategies do not always result in upgrades to revenue cycle functionality, and can actually add an unnecessary layer of complication to the project. If a hospital is using high-performance revenue cycle functions that are purpose-built for its organization, and its teams trust the data and the processes, it's important to keep those systems in place and optimize them to the EMR.

Sometimes, fully leveraging a new EMR's capabilities is a matter of turning on additional functionality in the existing revenue cycle technology that was not able to work with the legacy system. So, before any replacement strategy is pursued, hospital administrators should work closely with technology partners to make sure they are making full use of existing trusted systems.

Take a Proactive Role in EMR Migrations

Hospital administrators should not sit back passively and let their new EMR make wholesale (unnecessary) changes to the technology that manages cash flow. It's important to weigh the true cost of changing out revenue cycle technology especially during an already tumultuous core system change. Replacement can be expensive, time consuming, and potentially detrimental to both operations and revenue.

Best Practices for Hospital Electronic Medical Record Migrations GraphicTake an active and informed role in contract details, and weigh the true value of all offers. The high cost of “free” can be another area of risk. When it comes to healthcare reimbursement, 'good' is indeed the enemy of 'great,' so don't let a 'good enough' process supplant one that is already optimized. Short-term savings often come with high long-term costs in areas of efficiency, flexibility and opportunity. Hospital administrators need to fully understand what benefits they could be sacrificing and what revenue cycle processes could be impacted by changing technology.

For example, in changing claims management systems, hospital administrators need to understand any proposed vendor's capabilities around patient estimation and collections, quality assurance, claim editing, Medicare claims processing, process automation, secondary claims, claim follow-up workflow, remittance management, and more. All of these elements impact the speed of payment and utilization of their revenue cycle staff.

And hospital administrators should not evaluate processes within a vacuum - during or after the EMR conversion. Do they have the right external analytics to measure performance objectively? Recently, we worked with a 2,500-bed health system that suffered from skyrocketing CCI errors and slower cash flow during an EMR migration. Using analytics, they gained visibility into sources of errors, how often they were recurring, and how to fix them. The result: an overall acceptance rate that soared from 65% to over 90% (during the first 90 days), and charges for CCI errors plummeting from $120M to $1M.

Keep Revenue Cycle Top-of-Mind

It is essential for revenue cycle leaders to maintain a seat at the table during an EMR migration to ensure that revenue cycle vendors are proactively working with the core system vendor. These vendors need to have a strong working relationship with one another so that the clinical and financial elements of the project remain in sync. Hospital administrators should ask vendors for best practices for integrating systems. A credible revenue cycle vendor will have experience with most popular EMR systems and will be able to guide them through the process of integrating systems with minimal disruption to their cash flow.

From the revenue cycle perspective, a successful EMR migration is about maintaining focus. Hospital administrators should optimize their existing technology, change as few things as possible, and continually monitor, measure and review.

Ways to Measure Performance

Successful revenue cycle management is all about monitoring performance and using data to target process improvements. While day-to-day revenue cycle management involves many key performance indicators (KPIs), here are four strong metrics to watch closely during disruptive change:

  • Service to Payment Velocity - How fast are hospitals getting paid? A/R days is the standard industry metric for EMR measure. Increases, obviously, are an issue and usually indicate a process improvement opportunity. Hospitals really need a birds-eye view of how long each part of their claims cycle is - with EMR perspective to see if the slowdown is on their side (how fast they are getting the claim out) versus delays with their payers.
  • Discharged Not Final Billed (DNFB) - Probably the best indicator for performance. At a high level, DNFB shows hospitals how long it is taking to get a claim out the door. Establishing integration points between systems in the initial setup of new technology can impact backbone processes of the revenue cycle. Keeping a close eye on these metrics can alert hospitals to something that may need tweaking.
  • Charge Trends - An EMR implementation profoundly impacts hospitals' clinical departments. It's important to watch for any delays from these areas to pinpoint which departments may not be submitting charges as quickly as before because of changes in the EMR.
  • Denial Rates - Identifying and categorizing root cause of denials as quickly as possible and having the data to prove it can help reestablish processes that may be knocked out of alignment during a system change. Hospitals should set up alerts for timely filing thresholds as well. During a big change like an EMR implementation, a hospital's team could get distracted for various reasons and accidentally miss filing deadlines.
Core Systems Change Checklist

EHR-EMR migrations can prove costly when the revenue cycle is not made a priority. Here are some tips for maintaining fiscal fitness during the project:

  • Work with technology partners to establish regular communication touch points in order to properly manage the project.
  • Identify a project manager for the revenue cycle portion of the EMR migration, and make sure that person is engaged throughout the migration.
  • As a coordinated team, make sure fundamental decisions are made - such as mapping the flow of data between systems - and determine which technology will be used to manage each part of the revenue cycle process.
  • Lean on revenue cycle technology partners to recommend best practices for maintaining revenue cycle performance and consolidating systems. If they do not have any advice to offer, it should give an organization pause about moving forward with them.
  • Evaluate other capabilities from current technology partners to ensure an organization is getting the most out of their current investment. Identify opportunities to convert and consolidate.

To learn more about insights on successful EMR strategies, read Maintain Healthy Revenue During An EMR Transition.

Related: Learn about McKesson's Electronic Health Records Solution

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About the author

David Dyke is vice president of Product Management and Business Development for RelayHealth Financial. In his role as vice president of product management and business development for McKesson's RelayHealth Financial, David Dyke applies expertise gained over more than 18 years of experience across many areas of the healthcare revenue cycle and receivables management. He is passionate about helping hospitals, practices and specialty providers realize their financial potential while boosting patient satisfaction.

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