Healthcare is often reactive, rather than proactive, when it comes to opportunities for improvement. It is often a race to fix what went wrong, not to institute infrastructure to prevent it.
Linked to the above 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 does not treat patients, but is often somewhat easier to interpret as administrative, as many medical practices only focus on raising incentive dollars.
EMR / EHR companies are using each and every angle they can to make their product stand out from the rest. Some EHR / EMR providers include billing software and tell the providers that their EMR “software” handles billing as well. They also drive the fact that the EMR and billing are “linked” to each other. They tell their prospects that they can save money by not hiring a billing service that handles billing and collections (Revenue Cycle Management), but anyone who is an RCM expert knows that this is simply 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 internally. In reality, most providers that outsource your medical billing already have software capable of billing. The problem for most providers who choose to outsource is that they realize that they must maximize their reimbursement at all times and that they do not have experienced staff who expertly and consistently handle billing, claim tracking, calls telephone calls, the denial and appeal process. keep up with the ever-changing health care mandate, clearinghouse and e-filings, accreditation and recognize that the experience they gain from outsourcing their billing and collections to a billing company is crucial to keeping the doors open. Many providers find that they save money by outsourcing. Some have difficulty hiring, training, and keeping a knowledgeable person in that position in their office.
Simply put, no matter how good your billing software is, it is only as good as the person using it. The income of a provider depends on the billing. If they don’t, they will lose money, no matter how good your software is and whether or not it’s tied to your 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 – Can’t 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 – That said, it is necessary to have vendors and staff on board 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, they have the vision of how it could work.
3. Robust Software That Emphasizes Practice Specifications – Define what billing data you would like to capture by practice that is specific to your practice and / or specialty. Does EMR convert encounters / superbills into claims? Do you have an “interface” with your practice management software? Otherwise, the process will definitely add to the time and cost of the practice. The application of fees, taxes, and discounts for correct claims should be applied to the practices of this function (essential for ophthalmology and optometry).
4. Real-Time Electronic Eligibility and Electronic Claims Filing – These characteristics must be on any EMR / EHR. Is the software capable of verifying patient eligibility in real time? Will the clearinghouse provide direct verification of claims?
5. Strong accounting and financial reporting – Report management is a must for any billing function of an EMR / EHR.
6. Electronic payment tracking: all details must be tracked in the payment process. Features should include the ability to record and communicate every action taken to get a claim 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 rejection, and gives practice the opportunity to monitor red flags as they arise and implement types of audits.
8. Billing Codes Extracted Directly from EMR / EHR – This automated feature includes extracting (interconnecting) 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 built-in Meaningful Use Dashboard helps vendors track progress toward meeting Significant Use certification.
9. Multi-user, safe and easy to use – Users should be able to use powerful integrated claims editing solutions, claims status technology that automatically verifies claims status to improve reimbursement, automatic claim submission, to name a few.
10. Data monitoring, backup and recovery: Prevention is always the best measure and a system must be firmly established for monitoring and backups of the system.