Implementing Epic is a significant transformation for any healthcare organization. While the platform offers unparalleled capabilities in revenue cycle management, failing to conduct a thorough revenue cycle assessment of your current state before beginning the implementation journey may lead to operational disruptions, financial instability, and missed improvement opportunities. By proactively evaluating existing legacy processes, leadership structures, financial opportunities, and current system integrations (both bolt-on and process partners), organizations can streamline implementation and position themselves for long-term success.
Here are some of the activities and benefits of a comprehensive revenue cycle assessment prior to launching an Epic implementation:
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Assessment of leadership depth and a critical evaluation of organizational operational readiness
Epic implementations demand extensive leadership engagement at every level of the organization. However, this raises a critical question: Do you have the leadership depth to sustain daily operations while key personnel are redeployed to focus on system implementation?
Epic will require key resources to be redeployed on a full-time basis to the implementation effort, and this will leave a gap from their current operational responsibilities.
A revenue cycle assessment helps determine whether additional line managers and/or supervisors are needed to ensure uninterrupted patient billing and collections during the transition. If gaps exist, organizations can proactively train or hire interim leadership resources to plug those potential gaps.
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Identification of short-term financial benefits and/or cash acceleration opportunities
Major system implementations often cause a temporary (and sometimes longer) dips in revenue cycle performance and these dips can lead to a negative cash flow impact. To mitigate this risk, it is essential to identify and capitalize on short-term financial opportunities before go-live.
- Are there billing inefficiencies that can be addressed pre-implementation to accelerate cash flow?
- Can claims be processed more aggressively to reduce the risk of post-implementation slowdowns?
- Are there any critical root cause denial issues that need to be addressed that first, may lead to some short-term resolution, and second can be addressed during implementation process leveraging core functionality and providing for a longer-term solution?
- Do you have a strong wind-down plan for managing legacy accounts receivable (AR)? For more information on wind-down plan see: Key Considerations for Legacy AR Rundown Strategy
A revenue cycle assessment ensures that these opportunities are not overlooked, allowing the organization to maintain financial stability throughout the implementation process and system transition and reduce the negative impact of the implementation process.
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Establishing key metrics for “back to baseline” and post-go-live performance monitoring
After go-live, organizations desire to quickly return to pre-conversion baseline performance. However, without defined metrics based on current actual performance, it is difficult to measure success or identify areas needing course correction post go-live.
A comprehensive assessment helps to:
- Establish key revenue cycle metrics before implementation.
- Set realistic performance targets for staff and system integration partners.
- Develop a structured milestone-driven recovery plan post go-live.
By proactively defining these metrics, organizations can ensure an efficient “back to baseline” operations and begin considering revenue optimization initiatives after Epic is live.
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Understanding existing revenue cycle processes (and limitations) for implementation
One of the biggest mistakes organizations make is recreating old, inefficient processes in a new system. Epic offers advanced automation and workflow efficiencies, but, to leverage them, organizations must first understand where current processes fall short and consider these processes against Epic’s more robust capabilities.
A revenue cycle assessment allows organizations to:
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- Identify existing systems’ weaknesses and bounce against Epic’s capabilities
- Identify repetitive steps that can be automated.
- Eliminate unnecessary workarounds that add complexity.
- Replace error-prone processes with system rules and hard-stop alerts.
- Ensure Epic’s functional capabilities are fully utilized.
- Develop a process road map to enable a more effective design process.
By mapping out existing processes before implementation, healthcare organizations can avoid replicating inefficiencies and instead harness the full potential of Epic.
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Evaluation of bolt-on systems and vendor dependencies
Most healthcare organizations use third-party systems and partners for tasks like financial verification, charging/coding integrity, billing/clearinghouse, low-balance management, self-pay collections, bad debt recovery.
A revenue cycle assessment helps organizations:
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- Identify which third-party systems are performing effectively and should be considered in the new environment.
- Determine whether certain vendor relationships should be reevaluated or rationalized in the Epic environment. There will likely be functionality in Epic that will result in the elimination of bolt-on vendors and/or process partners.
- Ensure seamless integration between Epic and retained external systems.
By addressing these questions early, organizations avoid redundant costs, integration issues, and operational disruptions through the implementation process.
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Identification and resolution of data quality issues
Data integrity is the foundation of a successful Epic implementation.
Incomplete, inaccurate, or outdated data can lead to billing errors, claim denials, and revenue loss. A pre-implementation assessment can help to:
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- Identify data discrepancies in patient demographics, insurance information, and charge capture records.
- Address inconsistencies in coding, payer contracts, and charge master fee schedules.
- Establish clear, consistent data governance protocols to maintain accuracy throughout the transition.
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Engagement of clinical partners for revenue cycle alignment
A well-functioning revenue cycle is deeply connected to clinical operations. Engaging referring providers, case management, utilization review, and other clinical teams ensures that revenue cycle optimization efforts align with patient care processes.
A revenue cycle assessment helps:
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- Identify gaps in provider preferences and templates that impact scheduling.
- Uncover opportunities in clinical documentation that impact billing.
- Improve communication and collaboration between clinical and financial teams.
- Ensure that case management and utilization review processes support revenue integrity.
- Leverages the power of the Epic functionality in clinical areas to improve billing accuracy and avoid medical necessity issues
Without this collaboration, organizations risk coding errors, compliance issues, and claim denials that impact financial performance.
Conclusion: A proactive approach to Epic implementation success
Performing a comprehensive revenue cycle assessment before implementing Epic is not just beneficial—it is essential. By proactively identifying leadership gaps, financial opportunities, key performance metrics, and process inefficiencies, organizations can ensure a smooth transition and maximize the value of their Epic investment.
At Pinnacle Healthcare Advisors, we specialize in helping organizations navigate the complexities of Epic implementations. Our expert team can guide you through a strategic revenue cycle assessment, ensuring your organization is prepared for success.
Ready to Optimize Your Revenue Cycle Before Epic Implementation?
Contact us today at [email protected] or [email protected] to learn how we can help you achieve a seamless transition with lasting financial impact.
