March, 2013:

Upgrading to Allscripts v11.4

All healthcare organizations are in the process of preparing for ICD-10 and the continued march toward full Meaningful Use of their respective EHR vendor systems.  For Allscripts Enterprise clients this means an upgrade to v11.4 which is a multi-phase project.   Part of the start up phase includes installing and running the Problem Mapping Tool (PMT).  This is the key first step in the project because Allscripts will only assign an upgrade slot after the tool has been installed, run and the mapping completed.  All ICD-9 codes and custom form Medcin findings need to be mapped and this is expected to be approximately a 100 hour effort.  A review of your technical environment is also required because new server(s) may be needed to support v11.4.

Clients will work with Allscripts to create a project timeline based on the complexity of their respective environments taking into account the number of Allscripts modules installed, the number of interfaces and any other processes that are dependent on the Allscripts system.  When the client’s system environment and project team is in place, v11.4 will be installed and the project will follow the plan and timeline established.  Fully testing the Allscripts modules and integrated workflows is the key success factor for the upgrade.  For an average multi-specialty group it is expected to require 400 hours of effort to complete the upgrade and this does not include the PMT effort described above.

We hope that all of our Allscripts clients have started their upgrade planning to ensure compliance with the October 1, 2014 deadline for ICD-10.

Performance Reporting Using Allscripts PM

Physicians and their practice managers need an efficient and systematic way to monitor financial performance.  The standard “bottom-line” measures focus on provider productivity and aged accounts receivable (A/R).  Additional operational measures are useful to identify and respond to common problems in the revenue cycle, such as missing charges or claim denials related to insurance eligibility.  How can practices best use the reports and functionality available in Allscripts PM?

Practices may track productivity based on charges, payments, or work relative value units (wRVUs), depending on their provider compensation formula.  For payments and charges, we recommend the Productivity Analysis report, which is run by monthly reporting period based on updated transactions.  For wRVUs, we recommend the Procedure Analysis report – which is also useful to show the detailed visit volume by CPT code.  Only the Performance Management report can show productivity by service date;  however, the data are computed based on the original charge (not updated transactions) so the numbers change when that report is run at different times, as payments and voids are entered.  Also, it should be noted that none of the reports count unassigned payments until they are applied to charges.

The Aged Trial Balance report shows A/R in 30-day aging bracket, and is usually formatted by insurance category (Blue Cross, Medicare, etc.).  It can be run three different ways – by service date, billing date, and original billing date reflecting transfers.  While the first best reflects overall cash flow, the third best reflects billing office performance.  The limitation of the second is that, when a claim is rebilled (for example, to appeal a denial or correct a claim format error), the billing date changes to the new one and the A/R bracket is adjusted accordingly.  We recommend creating a spreadsheet to compile the data and compute percentages, to make it possible to track performance trends.  Monthly tracking is sufficient if A/R is mostly current (< 30 days), but weekly or biweekly is better if there is significant old A/R.  The A/R Analysis report computes average A/R days, a good indicator to compare with other practices.

In addition to those statistical reports, a few key operational reports are well-worth monitoring.  The Appointment Analysis report can be used to compute utilization of the scheduling template by provider.  The Encounter Tracking report identifies missing charges for scheduled visits;  if this is a significant problem, the data can be exported to a spreadsheet-file for analysis and distribution to providers.  The Reimbursement Comment Analysis report summarizes claim denial reasons;  categories can be set-up and linked to simplify reporting (for example, coding or insurance eligibility) and provide feedback and follow-up training for providers and practice staff.

The Office Manager module is also a valuable tool for monitoring operational performance in real-time.  Automated work queues and work groups can be set-up for staff to facilitate their assigned follow-up work (for example, referral authorization or denied claims).  Managers then have a simple transparent way to oversee workloads and progress in working-down backlogs.  In our experience, the Workflow Organization option to prioritize queues is advantageous, especially for clients with significantly old A/R.

Revenue Cycle System Vendor Selection

Have you ever wished for an easier way to obtain financial data to manage your bottom line?  Have you stressed over the fact that you cannot access crucial data in a timely manner?  Do you have more work-around processes than you would like?  Is accuracy a problem?  It may be time to think seriously about a change in your revenue cycle management systems.

Thinking about the revenue cycle of the future we can predict early and accurate patient identification that allows for proper registration and a completely automated pre-arrival process.  Patients will have access via portals to book their own appointments and to read and review medical records and care instructions. Insurance eligibility can be verified without any staff intervention and authorizations can be requested/obtained and stored prior to the patient arrival.  Accurate quotes for needed services can be easily generated and integrated with the patient’s propensity to pay.  Referral to insurance exchanges, integrated Medicaid applications and integrated contract management can insure a cash flow that is much more predictable and returned in fewer AR days than in years past.  Reliable integration between HIE’s, your revenue cycle and your electronic medical record can also benefit your meaningful use reporting.   Does this sound too good to be true?

 In a recent engagement for a large health network, Culbert was asked to(1)  evaluate acute, ambulatory and post-acute revenue cycle flow, (2) evaluate and identify all of the current technology in use, and (3) identify the areas where improved revenue cycle system features were needed.  The initial assessment identified significant workflow breakdowns caused by the inability to accurately share patient registration data between their many separate vendor systems.  Whether the breakdown was between facilities, physician practices or in the post-acute setting, the effort to re-work, correct and band-aid processes was no longer working effectively. Redundancy in the patient registration process was a huge patient dissatisfier, a cause for increased duplicate registrations and contributed to inflated staffing levels to constantly monitor and correct the errors. 

Culbert Healthcare Solutions has built a successful interview tool that allows for intensive data gathering and data comparison across all aspects of all revenue cycle teams.  Interviews were hosted with IT Analysis’, ED Registrars, Billing office managers and staff, Clinic Schedulers, Ancillary Services, Post-Acute care setting staff, Finance, Pharmacy, Customer Service, affiliates and contract management support to name a few.  Observations were performed to validate the interview results and Culbert worked closely with IT to call out the many additional add-on vendor products used to support the primary revenue cycle applications.  Executive feedback to the future vision and mission of the organization rounded out the footprint used for a Request for Proposal (RFP) to select a new revenue cycle vendor.

Epic Community Connect


Training-Enhancing User Acceptance

We’re all aware of the Epic Community Connect program and the plethora of benefits it provides to both the host organization and the independent practices and community hospitals that are its focus. Depending on your organization’s decisions around subsidy levels in relation to Stark laws, a lot of directors and project managers are struggling to develop their approaches on how to best staff these projects, implementation timelines, customization and ongoing support. As community connect initiatives continue to evolve and mature most organizations have made the decision to use existing build and clinical content as the foundation for these new sites to reduce implementation time and costs. Depending on the organizations current staffing levels, billing solutions, and interfacing capabilities, some have opted to create/hire dedicated teams for the project running the spectrum to clinical analysts to Cadence, Prelude, and Resolute analysts all of which can bloat a budget and call into question, how much of a long term expense can they incur once the community connect project slows or ends. One often ignored facet to this equation is training. 


A correlation between user acceptance and long-term support needs and inadequate training has been observed at organizations. What has been reported by clients and consultants is that training was one of the facets to be reduced as a result of cutting costs. Many times the host organization does not have the resources to staff their internal implementation, optimization, and new hire training along with a Community Connect initiative. The additional cost of expanding a training team through direct hire or staff augmentation is not as palatable and in many cases manifests as less classroom education for clinicians and staff. A trend of relying on e-learning has been observed and that in turn has been linked concretely to a lack of understanding of the Epic suite, unreasonable expectations, more elbow support post golive, and a need of heavy long-term support. While an added expense in the short-term, a dedicated or at least augmented internal training team capable of giving adequate hands-on classroom training will allow an organization to adhere to timelines and most importantly foster strong user acceptance that allows your new partnership to start off on the right footing and give the users a sense of dedication and support from the host.