Electronic medical records have become one of the technology tools to which many healthcare organizations have turned in their efforts to transform their operations. The idea is that automation and ready availability of information can help improve the quality of patient care, outcomes, and business practices at the same time. Patient health will improve while providers better avoid making mistakes and reduce rework and the necessary expenses it entails.
Technology can be a great aid to managing a business. It also inevitably comes with challenges. Implementing any piece of technology can affect existing computer systems, business processes, automation supporting those processes, reporting for decision support, critical business practices, and a host of other considerations.
EMRs are no different. In addition to the good they can provide, their implementation could potentially kick up a ruckus. One area of weakness is in revenue cycle management, as David Dyke, vice president of product management at software vendor and consultancy RelayHealth Financial, writes.
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.
According to Oregon Health & Science University, the revenue cycle “includes the entire life of a patient account from creation to payment.” Some of the aspects are patient intake and registration, diagnosis coding after examination, claim submission, patient collection, and remittance processing.
Critical parts of this process depend on what happens in patient treatment, which now includes collecting the information necessary to satisfy insurance companies. Implementation of EMRs means a shift in where the data comes from and a potential weak spot that can undermine the revenue cycle.
Dyke warns of the ripple effects of a new or upgraded EMR implementation. If new functions don’t work smoothly with existing revenue cycle management, the result can be a significant slowing of collection and, therefore, a problem with cash flow. Even an EMR system that promises “good enough” revenue cycle management can be a problem. Any slowdown in the billing and collections process increases cost of operations by keeping less cash on hand and increasing the reliance on financing. Some of the areas that can be affected include “patient estimation and collections, quality assurance, claim editing, Medicare claims processing, process automation, secondary claims, claim follow-up workflow, remittance management, and more.”
Even if there are changes that appear to make sense on the surface, Dyke suggests to run analytics to see how revenue cycle performance might change and pinpoint problematic areas if things go awry.
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