Leaders in the Business Office and Revenue Integrity departments of a healthcare organization have a difficult job to do. With job security reliant on hitting financial KPIs, bringing in cash is the number one focus of these departments. The overall focus of healthcare providers and organizations is to provide excellent patient care. But these two goals don’t always go hand-in-hand. The disconnect between clinicians and the finance departments put these healthcare organizations at risk across the nation.
The goal of the finance department is to drive business and achieve revenue goals. However, this goal is heavily reliant on the clinicians knowing and understanding the charging process of the EHR so that charges are billed correctly. This pressure can impede clinicians’ focus on providing excellent healthcare.
Softek Solutions works with hundreds of facilities across North America, helping clients optimize their Cerner® EHR through software. While working with the finance departments at these organizations, what we have seen has been eye-opening.
There is an obvious disconnect at many healthcare organizations between the finance side and the clinical side at many facilities we engage with. When Softek comes in for a revenue optimization project, one of the first steps is to ensure that all orders being placed within the client’s (Cerner®) EHR are posting appropriate charges. Inevitably what we notice are issues where chargeable orders are being placed but are never generating charges.
So how does this happen?
It’s quite simple: Communication.
When an orderable item is created within an organization’s EHR, the clinical orders team must communicate with revenue integrity or the charge master before the order is visible in their production environment. If an order is created simply because clinicians need it urgently, the escalation on the clinical side can often bypass a client’s internal processes. What this results in is an order being placed, performed, yet no charges are created to credit the work being done. In this instance, it is imperative to ensure that charge “build” is added before allowing these orders to be used at the facility. Skipping these critical steps and lacking the communication between the finance and clinical side can result in thousands or even millions of dollars in missing charges.
Clinicians are focused on providing excellent patient care as they should be. Finance departments are focused on bringing revenue into the organization, but some parts of the charging process are outside of their control. Therefore, it is critical for the finance and clinical staff to work together on understanding the charging process.
Many organizations receive less than four hours of training on their EHR system once it is implemented. Four hours. Can you imagine only receiving four hours of job training on a complicated, customized system that you’re expected to use every day?
On top of that, these individuals oftentimes weren’t part of the build or implementation process, so they don’t understand the ins and outs of the system and why processes were created the way they were.
This is why it is imperative that both the finance and clinical staff be fully trained on their EHR and work together on the charging process to ensure all goals can be met and organizations can provide excellent patient care while achieving their revenue goals.