Implementing an Electronic Health Record (EHR) system, like Epic, can significantly transform healthcare organizations, bringing long-term benefits but often disrupting revenue cycle operations. Establishing clear return-to-baseline targets helps track success post-implementation and ensures financial stability. While returning to prior performance is a short-term goal, the long-term objective is to outperform past targets and improve revenue realization rates. This article highlights key metrics to monitor, strategies for surpassing baselines, and expected timelines for recovery.
Key Metrics to Track for Pre- and Post-Implementation Success
It seems the highest priority in any go-live situation is to preserve and maximize revenue. To measure success and minimize revenue disruption post-Epic go-live, organizations will likely have a broad range of key revenue cycle metrics they may wish to monitor. However, revenue driving metrics are the highest priority metrics post go-live. Primary focus areas are:
Clean Claim Rate, Charging Stabilization, Efficient Registration
- Baseline Target: Claim acceptance rate >97%, Charging baseline of 96% (HB) and 92% (PB), Registration times under 5 minutes.
- Post Go-Live Expectation: Expect declines due to documentation issues, insurance discrepancies, or system configuration mismatches.
- Return-to-Baseline Target: Achieve within 30-45 days through issue resolution, training, and system optimization.
Coding Transition and Billing Edits
- Baseline Targets: Coders working primarily in Epic, coding AR days <2 days, billing edits reviewed within 5-8 days, and charges captured within 24-48 hours.
- Post-Go-Live Expectation: Focus on legacy accounts and Epic coding, with billing edits monitored.
- Return-to-Baseline Target: Stabilize within 45-60 days with staff training and workflow optimization.
Read more about Bringing Transparency to Epic Hospital Billing.
Coding Transition and Billing Edits
Revenue generating focus will eventually shift to downstream transaction performance areas including payment posting, adjustments, and Denial tracking for both Hospital and Physician Billing. Of course, the transaction level performance will lead to monthly close activities and month-end reporting to include AR days, payment variance reporting, and trending analysis.
Days in Accounts Receivable (A/R)
- Baseline Target: Gross A/R days between 30-45, depending on payer mix.
- Post-Go-Live Expectation: A temporary increase due to process inefficiencies and system learning curves.
- Return-to-Baseline Target: Return to baseline within 90-180 days.
Read more about Epic AR management and Pre AR management.
Denial Rate
- Baseline Target: Denial rates under 10%.
- Post-Go-Live Expectation: Increased denials due to errors or mismanaged claims.
- Return-to-Baseline Target: Regain control within 90-150 days with root-cause analysis.
Cash Collections as a Percentage of Net Revenue
- Baseline Metric: Consistently collecting 95%+ of expected net revenue is ideal.
- Post Go-Live Expectation: Decreased collections due to claim submission and processing delays.
- Return-to-Baseline Target: Recovery expected within 120–180 days, supported by workflow adjustments and claim resubmission efforts.
Planning and managing Returning to Performance Targets
Achieving baseline performance requires a structured approach, clear focus, and strong team engagement. Key steps include:
- Establish Pre-Go-Live Baselines
- Document historical performance data, considering changes like transitioning to a pure net revenue model.
- Utilize Monitoring and Reporting Tools
- Leverage Epic’s reporting tools to track performance in real-time and adjust goals as needed.
- Provide Staff Training and Support
- Offer role-specific training to reduce errors and improve system adoption. Encourage ownership of workflows.
- Engage Proactively with Payers
- Address claim rejections and denials early, ensuring smoother transitions.
- Optimize System Configurations
- Continuously refine charge capture, coding validation, and claims processes with system support.
- Develop a Recovery Timeline
- 0–30 Days Post Go-Live: Address immediate system issues.
- 30–90 Days: Stabilize workflows and refine claims processing.
- 90–180 Days: Achieve baseline performance across key metrics.
In summary, creating realistic, tailored baseline metrics and continuously improving performance allows healthcare organizations to minimize disruptions and maintain long-term revenue cycle efficiency.
At Pinnacle Healthcare Advisors, we specialize in helping organizations navigate the complexities of Epic implementations. Our expert team can guide you through the process of establishing, measuring, monitoring, and achieving baseline metrics ensuring your organization achieves implementation success in the revenue cycle.
Contact us today at [email protected] or [email protected] to learn how we can help you achieve a seamless transition with lasting financial impact.
