Workqueues (WQs), worklists, spreadsheets, reports. They are all trying to help us answer the same question: What accounts should we work and in what priority? How frequently is your PFS management team asking staff to re-sort their workqueues, work off spreadsheets for special projects, or work through a stack of paper denials? Workqueue build in Epic is one of the most critical pieces of your install and ongoing maintenance. After all, these are the primary workdrivers for your exception-based workflows. But are you really working the exceptions? Are your workqueues setup as effectively as you’ve been led to believe? Below, we’ll outline the questions you should be asking as you assess your current state workqueue build.
What is my workqueue structure?
On the surface, this seems like a simple question. Most of us have been through a workdriver design session where we outline what we need. Typically, the conversation centers around how many staff we have, who has expertise in what areas and what our volumes look like. Voila! Workqueue structure is complete. Seems simple right? Did anyone ever stop to ask the question about whether an account should be able to qualify for one or all those workqueues at once? If a patient has an outstanding balance on their primary insurance bucket due to an underpayment and an outstanding patient balance, the account could conceivably be in three places at once (insurance follow-up, variance, and self-pay). Who do I go to on my team to get the account resolved? This doesn’t even include any billing indicators that may drive it to specialty queues.
This is where an effective workqueue waterfall structure comes into play. Understanding how you need to break out your account populations (billing, government, commercial, self-pay, denials etc.) but also, prioritizing within those populations so that an account can’t move to point B until it has cleared point A. For example, an account shouldn’t be on a secondary insurance workqueue until the primary insurance has been resolved and has a $0 balance. Similarly, an account shouldn’t be on a self-pay workqueue if there is an open denial. The overarching goal should be to get as close to a 1:1 account to worklist ratio as possible with the understanding that there are always exceptions to the rule that are unique to each provider.
Do I have transparency?
The methodology behind workqueue build tends to slip over time. Issues are identified and workqueues are hastily put into place to house special projects. Staff and management transition in and out of roles and before you know it, your six months post live and your workqueues are out of date. The problem only grows over time.
There are a handful of “optional” components that are part of workqueue build that should be considered requirements both at the time of workqueue creation and as part of long term workqueue management. This includes descriptions, owners, supervisors, and groupers. Additionally, while workqueues do require a name, they do not require a consistent naming convention.
- Name – To help drive reporting transparency, similar workqueues should have similar naming conventions. For example, all billing workqueues could start with BIL, follow-up with FUP, and denials, with DEN. When developing workqueue reporting, this will help ensure like populations are grouped accordingly.
- Description – When a workqueue is three years old and the people who built it and worked it have long since departed, this is the best way to understand how and why this workqueue is in place. It is also critical for new hires that are starting to get their heads around their new workdrivers. A good description outlines the purpose of the workqueue, broad scope of what is included, and any specific carve outs. If WQ scoring is in place, the description should also provide an overview of high priority scoring logic.
- Owner – Who is the primary resource responsible for working the account populations? This is useful to drive reporting and accountability throughout the department. For reporting, you can see which staff have a large workload and triage accounts as necessary to help ensure I’m touching all high priority account populations.
- Supervisor – Similar to the owner, this can help leadership group and monitor their workqueues closely while also driving reporting transparency. As a PFS Director, if a workqueue doesn’t have a Supervisor, it either isn’t on my report or if it is, you don’t know who to go to for a status update.
- Grouper 1 and 2 – How quickly can you find all of your Medicare follow-up workqueues? Do you search the name for Medicare and get billing, follow-up, and denial results? This is where groupers come into play. Using two sets of groupers allow for multiple layers of filtering to more quickly access the workqueues you’re after. In the scenario above, grouper 1 may be follow-up and grouper 2 may be Medicare. These categories can also drive reporting and query functionality to allow for targeted report sets specific to the appropriate audience. Finally, groupers can help designate reporting only vs. actively managed workqueues to ensure reporting and workflows are clear and concise.
When was the last workqueue Clean-up and Refresh?
Anyone who has been live on Epic for more than six months likely has at least a handful of workqueues that can be removed or re-purposed. Frequent offenders include:
- Old special project queues – We frequently run into issues with account populations and the response is to create a workqueue and transfer all the accounts. 12 months later, there are still a handful of accounts sitting there and nobody is looking at them.
- Queues that haven’t been recently accessed – Search for workqueues that have not been accessed within a certain period. Inevitably, there will be some “holding” workqueues that need to remain, but those that haven’t been accessed recently either need to be assigned to staff or removed/re-purposed.
- Queues without ownership/supervisors – If a workqueue doesn’t have an owner/supervisor and if the volume of accounts is miniscule, odds are it needs to go or be re-assigned. Missing owners and supervisors can send accounts into a workqueue black hole where the account doesn’t qualify for the Watch List black hole metrics since it’s on a workqueue, but nobody knows the workqueue is in place, so the accounts aren’t being reviewed.
- Epic HB workqueues provide tremendous flexibility to triage and route accounts. Having a well-defined workqueue structure in place for each department can help minimize over-utilization of workqueues and keep workflows streamlined.
- Accurate routing and workqueue rules are critical to ensure that the functionality is aligned with the design structure. Specific metrics can be developed to monitor effectiveness.
- Key components of workqueue design and build should not be overlooked due to their impact on reporting and accountability. This includes workqueue names, descriptions, owners, supervisors, and groupers.
- Regular review and maintenance of your workqueue structure is critical to reduce overbuilding, maintain streamlined workflows and eliminate workqueue black holes. Dashboard functionality can be a useful tool to measure the health of your overall workqueue structure.
For more information related to Epic optimization or revenue cycle management, please contact Kevin at KBlanchard@PinnacleHCA.com.