Top 5 Missed Epic Revenue Cycle Optimization Opportunities

Epic is a platform within the healthcare industry which generates a strong love/hate relationship.  On one hand, it centralizes information and opens communication across the provider spectrum. On the other hand, many supposed efficiency gains are bogged down in tedious workflows while promised reporting transparency remains unavailable or hidden in a mountain of reporting options which may all yield different results.  Five examples of underutilized Epic functionality that revenue cycle leadership should evaluate include account prioritization (also known as workqueue scoring), activity code enhancement, simple visit coding (SVC), watch list development, and comprehensive workqueue re-design. Some of these concepts can be designed and implemented as part of an Epic installation while others are ideal for clients that have been live for a period.

Workqueue Scoring

A buzz phrase within the Epic community, workqueue scoring allows for the development of customized logic to prioritize accounts within a workqueue and group account populations into categories (i.e. 1-5) to drive end user productivity and reporting.  Leveraging scoring functionality can help reduce timely filing/appeal denials, drive up front collections, improve agings, increase effective account touches by staff, and bring to light delinquent account populations that may be eligible for outsourcing or internal clean-up initiatives.  

In addition to financial and productivity benefits, workqueue scoring can also help empower operational leadership to drive accountability by improving transparency around workqueue performance.  Leadership can provide feedback or triage staff based on the high priority volumes within each workqueue. This helps to ensure that all high priority accounts are worked within a timely manner, reducing financial risk to the provider.

Workqueue scoring can be a powerful tool when leveraged appropriately within patient access, HIM/coding, and Patient Financial Services.  It can help prioritize high risk/high opportunity account populations, while also giving tools to leadership to effectively manage their AR and staff.  The flexibility of workqueue scoring should empower leadership to improve financial performance while remaining flexible enough to target special projects and evolve as the business office book of business changes over time.  It is recommended that workqueue scoring be implemented in a limited fashion prior to go-live when possible and evolve over time as the AR continues to build and change. For those providers who are already live within Epic, a comprehensive workqueue scoring approach should be reviewed and implemented across all areas of the revenue cycle.

Activity Code Enhancement

Activity codes (also known as billing activities) in Epic are a frequently underutilized tool.  They can be used to drive system automation, increase productivity, improve interdepartmental communication, and help drive reporting around staff quality.  While Epic comes pre-populated with many different activity codes, often, they are not built out to adequately improve workflows and improve staff productivity.

Activity codes can be used to automate things such as outsourcing and insourcing accounts, account escalation, routing between departments, sending letters, and standardizing documentation.  Furthermore, activity codes can be given a score to help quantify the difficulty/importance of a task. These scores can help drive productivity reporting within Epic to help understand how effective staff are in their account touches.

Effective activity code build within Epic should be an opportunity to improve staff productivity, while also driving consistency and improving communication.  Activity code development can also drive quality metric reporting for management to better understand staff performance and drive improvement. Activity codes should be developed prior to go-live when possible and evaluated on a quarterly basis to ensure that they support existing revenue cycle workflows.

Simple Visit Coding

Simple visit coding is a frequently neglected, or only partially developed functionality within Epic.  As the name implies, Simple Visit Coding is a process that takes relatively “simple” outpatient visits and automates the coding process directly within Epic.  The end goal being for staff to work accounts on an exception basis. Simple Visit Coding leverages the diagnosis information combined with a late charge analysis to identify those populations of accounts that would be eligible for Simple Visit Coding.

Leveraging simple visit coding can help reduce DNFB/CFB days, leading to cash acceleration within the revenue cycle. Additionally, increased automation through simple visit coding can lead to staffing flexibility and efficiency gains.

It is recommended that simple visit coding be combined with flexible MinDays (suspense days), allowing for claims to be sent earlier and the payments received faster.  Simple visit coding should be implemented in a post-live environment once staff have become comfortable with workflows in Epic including charge entry, diagnoses documentation, and coding workflows.

Watch List

The Watch List is a component that can be plugged into Radar Dashboards within Epic that highlights key metrics within Patient Financial Services.  While the Watch List has improved over time, it remains one of the most powerful, yet underutilized tools within Epic.

The Watch List can be customized to track key high opportunity and/or high-risk account populations and trend those metrics over time based on volume and dollar.  Additionally, the dashboard includes drill-down functionality for root cause analysis and special projects.

Development of customized metrics can provide invaluable insight into the health of the revenue cycle and can drive cash improvement and reduce denials.  For example, metrics can highlight workqueue black hole account populations, workqueue overlap, upcoming timely filing/appeal deadlines, high dollar unbilled, vendor aged assignments, or uncoded account populations.

Watch List metrics can be implemented at any time pre or post live.  Metrics may need to be refined over time as system logic evolves and can be created and deactivated for special projects as necessary.  Finally, metrics can be customized to specific owning areas such as No Response, Billing, Denials, etc. to help drive ownership and accountability.

Workqueue Re-design

Workqueue re-design is a comprehensive assessment of existing workqueue logic and functionality across the revenue cycle.  Frequently, for clients who have been live on Epic for several years, the volume of workqueues required to be monitored by staff can increase to a point where it becomes difficult to manage.  Workqueues are neglected, ownership is not updated, descriptions are out of date, or the logic is not comprehensive to catch or eliminate specific account populations. Conversely, numerous staff may work out of a single workqueue utilizing Epic filters, which creates difficulty in driving staff accountability.

Workqueue re-design evaluates existing workqueue logic to find black holes or workqueue logic overlap, as well as delinquent workqueues that are not actively worked with an end goal of reducing the number of workqueues within the system and working to get closer to a single workqueue per staff member.  A waterfall logic approach is put in place to ensure that accounts reside in the highest priority workqueue and is resolved before moving along within the revenue cycle.

Workqueue re-design can be implemented as an enhancement to existing workqueues, or a complete workqueue re-build depending on the scope of the initiative.  Workqueue re-design is inherently a post-live optimization initiative, however, components behind the methodology can be incorporated into a pre-live environment to help manage future workqueue growth.

Parting Thoughts

  1. Epic is a large, robust tool which continues to evolve.  Healthcare organizations need to be aware of not only new functionality, but the effort and risk/reward to implement that functionality.
  2. System optimization can have numerous benefits including increased cash flow and net revenue, increased productivity and quality, improved standardization, and increased reporting transparency.  These items can help a revenue cycle operate as a more effective unit.
  3. Many pieces of functionality can be turned on in part and evolve or grow over time.  For example, workqueue scoring could be implemented only in the No Response workqueues and simple visit coding could be implemented for only a few departments.
  4. Organizations need to approach their workqueue build with a well thought out plan and commit to that plan over time to ensure the system remains manageable and fully functional.

For more information related to Epic optimization or revenue cycle management, please contact us at info@PinnacleHCA.com or via phone at 218.591.3607.

Pinnacle Welcomes Kevin Blanchard to the Team

We are pleased to announce Kevin Blanchard has joined the Pinnacle Healthcare Advisors team.  Kevin has extensive experience leading revenue cycle transformation engagements with large multi-system hospitals, pediatric hospitals and single-facility hospitals.  Kevin’s areas of expertise include Epic Resolute Hospital Billing optimization, workflow and work driver management, DNFB/CFB management, denials management, system automation, customer service/scripting and pre/point of service cash collections.

Kevin is actively involved in the ongoing development of our Epic enhancement solutions. Click here to read Kevin’s blog post, ‘Top 5 Missed Epic Revenue Cycle Optimization Opportunities”.

If you are interested in more information about reporting transparency, workqueue re-design and prioritization or account resolution, please contact us.