Medical care is often reactive, rather than proactive, when it comes to opportunities for improvement. It is often a race to fix what has gone wrong, not to institute infrastructure to prevent it.
Linked to this is the fact that EMR/EHR is a significant outlay of cash to providers for something that is not directly a medical product. EMR/EHR is not treating patients, but is often something that is more easily construed as administrative, as many medical offices are only focused on capturing incentive dollars.
EMR/EHR companies are using every angle they can to make their product stand out above the rest. Some EHR/EMR providers include billing software and tell providers that their EMR “software” also does the billing. They also drive the fact 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 handle billing and collections (Revenue Cycle Management), but anyone who is an RCM expert knows this is not true.
Personally, I see EMR as a totally separate entity from billing. Having billing software doesn’t mean it’s smarter for a provider to keep billing in-house. In reality, most providers that outsource their medical billing already have software capable of billing. The problem for most providers who choose to outsource is that they realize they must maximize their reimbursement at all times and do not have experienced staff who expertly and consistently handle billing, claims tracking, phone calls , denials, and the appeals process. keep up with ongoing changes in healthcare mandate, clearinghouse and electronic filings, accreditation and recognize that the experience they gain by outsourcing their billing and collections to a billing company is crucial to keeping doors open . Many providers find that they save money by outsourcing. Some have a hard time hiring, training and keeping a knowledgeable person in that position in their office.
Simply put, no matter how good your billing software is, it’s only as good as the person using it. A provider’s revenue depends on billing. If they don’t, they’ll lose money, no matter how good their software is and whether or not it’s tied to their EMR/EHR.
Ten key features within your EMR/EHR and Practice Management solution can help make the transition more efficient and provide you with some savings.
1. Implementation: It cannot be stressed enough. KNOW your needs and wants when choosing your EMR/PM solution. An EMR/EHR should enable medical practices to achieve greater patient efficiency by streamlining daily operations, strengthening the doctor-patient experience, and improving patient quality.
2. Management Commitment – With that said, having vendors and staff on board is necessary for a successful transition. Perhaps this means having a small but focused project team that is made up of “systems thinkers” – these are people who understand how the current organization works, but more importantly, have the vision for how it could work.
3. Robust software that emphasizes practice specifics – Define what billing data the practice would like to capture that is specific to your practice and/or specialty. Does the EMR convert encounters/overbills into claims? Does it “interface” with practice management software? If not, the process will definitely increase the time and cost of the practice. The correct application of charges, taxes and discounts for claims must be applied to this practice (critical for ophthalmology and optometry).
4. Real-Time Electronic Eligibility and Electronic Claims Submission: These features must be provided in any EMR/EHR. Is the software capable of verifying patient eligibility in real time? Will the clearinghouse provide direct verification of claims?
5. Robust Accounting and Financial Reporting – Reporting is a must for any billing feature of an EMR/EHR
6. Electronic Payment Tracking: All details must be tracked in the payment process. Features must include the ability to record and communicate every action taken in order for a claim to be paid.
7. Real-time claim rejection analysis: Error codes must be clearly displayed. This feature can allow users to: immediately resolve problematic claims, analyze the reasons for claim rejections, and provides the practice with the opportunity to monitor red flags as they arise and implement types of audits.
8. Billing Codes Pulled Directly from EMR/EHR – This automated feature includes pulling (interfacing) E/M codes and procedures directly from EMR/EHR documentation. By extracting patient data as it is entered during patient history, medical notes, pathology and radiology entries, procedures, and prescriptions, services rendered are immediately recorded.
The integrated Meaningful Use Dashboard helps providers track progress toward meeting Meaningful Use certification.
9. Multi-user, secure and easy to use – Users should be able to use powerful built-in claim editing solutions, claims status technology that automatically checks the status of claims to improve reimbursement, automatic claim submissions, to name a few.
10. Data monitoring, backup and recovery: Prevention is always the best course of action and there should be a robust system in place for system monitoring and backup.