Revenue Guardian is a module within Epic which identifies areas of opportunity to increase charging efficiency and more importantly, catch accounts with missing charges. If your healthcare organization is using Epic’s Resolute Hospital Billing application and you do not have a robust Revenue Guardian solution you may be missing out on revenue. To that end, there are many considerations when choosing to implement or improve your existing Revenue Guardian edits. If you are interested in other ways Epic can help your Revenue Cycle see Top 5 Missed Epic Revenue Cycle Optimization Opportunities
Revenue Guardian is a very powerful tool at your disposal as it can look at both billing data and clinical information to help identify missing or incorrect charges. Due to the nature of how Revenue Guardian edits are designed, you can look deeper into the chart for items which may indicate a service was performed, a supply was used, or a drug was administered. These edits are more robust than you would typically find in commonly deployed in billing edits. More information about how EHR platforms can help your RC see How to Determine if Your Current EHR Platform Can Solve Your Revenue Cycle Challenges
When optimizing Revenue Guardian the first step is to identify your areas of opportunity. Many areas of the hospital rely heavily on clinicians manually entering charges and anytime there is a manual charging practice there is room for errors and omissions. Other areas can be identified utilizing your reporting capabilities. For example, looking for service lines with poor charging practices and/or higher denial rates.
Once you have identified areas of focus, it’s time to get to work. Creating a strong interdisciplinary team to develop your Revenue Guardian program is an essential early activity. This group of experts should include Revenue Integrity, Coding and Billing but also adding subject matter experts from your identified clinical areas can help boost your program’s effectiveness and ultimately its ROI.
With your operational decision makers and reviewers in place you can engage with your Epic IT support staff to outline the goals of the program and start the pre-build analysis. It is critical that your IT resources are well versed in not only the Revenue Guardian build specifics, but also have knowledge concerning the clinical workflows. This will provide an advantage when it comes to building edits that encapsulate all the requisite activities associated with an encounter and are not one to one charging (ex. procedure missing device) issues.
The key to successful implementation of edits is thorough testing throughout the process. Identifying false positives and other charging practice nuances for your organization will not only help your end users who are reviewing the accounts but also increase their efficiency allowing them to complete their reviews quickly and accurately.
Once your program is up and running you should evaluate the rule sets annually to ensure all relevant build specifications are still up to date. Having a reviewer in place to identify any changes in CPT/HCPCS, ICD-10 codes and your CDM pays dividends allowing the system to correctly identify accounts with missing or incorrect charges and boosts your clean claim rates.
In summary, if you are using Epic Resolute Hospital Billing, the Revenue Guardian module can and should be used to its fullest extent. By creating a strong team to lead and build out the edits for the module you will not only increase revenue but may also increase charging efficiency and achieve lower denial rates. By keeping your edit rule sets updated you can ensure that you are capturing the right accounts for the right reasons and your account auditors will thank you as well. Other areas of interest relating to Epic Are Your Epic HB Workqueues Broken? Here’s How to Fix Them
At PinnacleHCA, we have an established strong track record of helping our clients optimize their Epic Revenue Guardian program and achieve their financial objectives. If you have any questions or concerns about your Revenue Guardian program, please feel free to reach out at [email protected].
