Factors to Consider When Choosing an Electronic Medical Records System for Your Organization
The use of Electronic Medical Records Systems (EMR) to collect their patients’ data realities of the patient experience. Today, 90 % or more of the patient experience is the result of their interaction with the front desk or patient intake side and billing. (The Practice Management Component)
Selecting an EMR/PM and Clearing House:
There are three things EMR Manufactures do not tell you:
One: On the EMR side of the equation they ALL do the same thing. They create patient notes – (The SOAP Note), they have e-prescribe capabilities, collaborative capabilities (everything from second opinions to pre-authorizations), provide historical data relating to the patient and they create a superbill to send to your billing and coding department for review and corrections before forwarding on to the clearinghouse and payers. Manufactures also spend a lot of time on front customization of screen views, and where tabs or buttons are located. Providers often have no idea how this affects the back end – i.e., the billing or Revenue Cycle Management side. Keep it Simple!
Two: THE NUMBER ONE FRUSTRATION PATIENTS HAVE IS WITH THEIR BILL! The overall patient satisfaction hinges mostly on their interactions with your billing department, office staff and the front desk, and the questions about their bill yet, manufactures only spend about 10% to 15% of their time on this part of the equation with regards to their software capabilities and their reports during the sales process.
The attention paid to the EMR side is not the same with the reimbursement side: The Practice Management component of the software and clearinghouse.
What sets the Practice Management components apart is the way claims are processed and the reports that are generated and their ongoing support.
An effective and efficient solution should incorporate the Clearinghouse, the Practice Management component and EMR in one software package from one vendor. This makes communication easier and solving issues more efficient and provides accountability when it all comes from the same vendor and more importantly provides for a more accurate patient account reconciliation and process. The increased efficiency lowers your possibility of submitting incorrect payers’ claims or incorrectly reconciling patient accounts by over 50%.
Having your Electronic Medical Records system, Practice Management System and Clearinghouse provided by the same vendor is key to the success of your organization and patient experience. This will result in:
● More transparent claims management and record their patient’s medical history is a necessity. In most cases, Practice Management Systems and Clearing Houses are included in the software package to track patient accounts and send claims to the payers but not always.
They are the most vital tool outside the personnel, in running a practice or hospital and serving your patient’s needs. However, with numerous EMR and Practice Management vendors, choosing the right one for your business is a daunting task.
First Rule: “Keep It Simple” The simpler it is to create a patient notes, E-prescribe and bill the patient, the better your patient experience and bottom line will be!
Manufactures spend most of their time in the sales process with healthcare organizations focusing on the EMR component instead of the patient account side. This is completely out of touch with the Less manual work exchanging information between your software vendors and that of your payers which leads to lower labor cost.
● Streamlined claims process.
● Improved patient collections
● Easier Reconciliation of Patient Accounts
● Better Patient Experience
Third: A.I, while it has it’s uses in healthcare, it simply does not work when it comes to processing claims. Many organizations have tried to use A.I or an all-in-one automated billing solution, but the truth is this often results in loss revenue because A.I cannot keep up with the software development on the payer side or the synchronization required between changes that are made by CMS / Medicare or payers during the year. This leads to providers not capturing all the revenue they are entitled to.
A Word About Automating EOBs
Two things that set the systems apart on the Practice Management component or Billing side of the equation, is how they process your claims with use of a clearinghouse and their ongoing support. A terrific way to settle claims effectively is by electronically receiving the EOB and remittance data into billing systems with the capability to audit EOBs for accuracy. If you choose to do it manually, you experience backlogs and delays, increased labor costs that restrict cash flow. Having clear concise clearing house reports, edits and reminders on coding that are automated and intuitive within the software and the ability to catch missed payments on partial claims or a process to reconcile the EOBs with the payment that is sent to the provider by the payer is also critical.
If the delays happen at the start of the process, it gets harder to meet secondary billing deadlines and denials. Automating EOBs helps you recognize your revenue and errors sooner while avoiding write-offs.
Once you extract all the data required to reconcile EOB forms from faxed or scanned documents, you should have the ability to upload it into your billing systems and identify exceptions faster. Your employees can focus on managing denials and resolving exceptions instead of doing manual data entry, which is tedious and costly.
With EOB automation, your staff are relieved of the burden of manual input, and your providers can manage volume peaks without missing deadlines or incurring more costs by hiring additional staff.
Another advantage of automated EOB processing is your employees will be more efficient locating digital documents in case of denials and queries. Instead of wasting time browsing through paper documents, making their copies, and forwarding them to payers, employees can focus on customer service and cash flow.
The second item that sets vendors apart is their support. Some vendors still require a ticket for each topic or issue, and this often leads to delays in processing claims or patient reconciliation thus delaying your money coming in and increasing labor cost. Some of the areas you should cover about support prior to signing the contract are:
1. When it comes to changes in coding, billing, value-based vs ala-cart system, or process
issues, how does your vendor provide support or training now during the grace period or initial contract and how do they do this for future needs? Is there an additional cost for training for future needs?
2. Do you have to put tickets in for every question or issue or can you make one call to get all your questions answered in that call or a follow up call in 24 to 48 hours? Note: You will have as many questions day one as you will in year 3. Revenue Cycle is always evolving and new determinations by Medicare come out monthly which affects software upgrades and processes.
Your vendor should have a staff that can answer your questions with the least number of calls and provide research and follow up with you proactively when needed. Spend time exploring this aspect when deciding on an EMR and PM vendor to set the expectations up front before contracts are signed, you will be glad you did. Keep in mind that the Healthcare Industry since 2015 has been changing rapidly when it comes to reimbursements, coding, and medical necessity
"Having a vendor that is willing to provide you with on demand support is vital to the financial health of your practice."
You need to be incredibly careful choosing the right Electronic Medical Records System vendor for your practice. The right solution and vendor will incorporate all 3 components in one solution. (The EMR, Practice Management and Clearinghouse from one vendor). Reports with regards to your AR and patient accounts need to be easy to understand, correct and can export to excel in addition to providing reports to accurately reconcile your patient accounts and not automatically push balances to patient responsibility without the ability to audit the EOB vs payments. More than anything else, get it in writing!
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