January, 2014:

Epic-Workqueue Optimization

Workqueues in Epic provide powerful functionality to keep business operations running smooth.  Epic’s revenue cycle users depend on efficient, streamlined algorithms to organize, prioritize and drive information management and follow-up. 

Different workqueue types include Charge Review, Charge Router, Claim Edit, Credit, Remittance, Claim Follow-Up, Retro Review, Patient, and Accounts.  Each workqueue type will serve to hold problematic records at different stages of the revenue cycle.  Improved workflow efficiency, reduced lag time between manual corrections and faster issue identification are all possible – if your workqueues are setup correctly!

Most organizations build workqueues using Epic’s Model System rules in combination with “home-grown” coding and payor-specific rules that impact registration and reimbursement.  The effectiveness of each workqueue depends on the quality of the rules that identify records for follow-up.  The most effective organizations are committed to maintaining and optimizing their workqueues to meet evolving organizational, coding and/or reimbursement changes.

Some of the more common challenges faced with maintaining workqueues include:

  • Poor understanding of payor requirements that leads to inadequately written workqueue rules
  • Identifying the most appropriate workqueue for an error
    • For example, Registration errors should land in a patient workqueue for resolution by front office staff.  This allows charges to enter the system with clean demographics and insurance data, allowing for improved processing in the revenue cycle.
  • Optimizing auto-processing functionality within the workqueue allowing the system to resolve errors without human intervention
    • For example, building criteria for Credit workqueues to automatically match undistributed payments with open charges is possible.

Build can be as simple or complex as desired.  The most successful organizations are committed to continual review and maintenance of their workqueues, learning from past failures while striving to improve the efficiency and workflow of its users. 

Have you received feedback from end users that can be incorporated into your support process? Is it time to give your Workqueues a check-up?


ETM: What’s New with Enterprise Task Manager

Enterprise Task Manager (ETM) began its life as an application to assist clients with accounts receivable follow up efforts within the BAR functions. As ETM evolved, it became an application that could address the front-end edits through integration with TES. The continuing evolution integrates ETM with other billing and collection processes and has become a solution that can address the entire revenue cycle – not just the post claims processing stage.

In early versions of ETM, the starting workflow package included:  BAR workflows for Insurance Followup, Rejections Followup, Self-Pay Followup and Claim Edits.  Underpayments were offered, but without Payer Contract Module, were not very useful.  The next workflow that GE came out with was TES edit workflows. 

The Transaction Editing System (TES) Workflow was introduced with v5.0 and creates tasks from the edits you choose to work in ETM.  Transaction-level tasks show all edits for the transaction listed in the Preview and Instruction panes.  Transaction edit tasks show each edit as an individual task unless you use the roll up functionality for identical dictionary field edits or all registration/insurance edits for the same patient into a single task.  The rollup functionality can streamline the working of TES edits and reduce system overhead when the old TES workfiles required nightly compiles.

The newest additions are workflow enhancements that support EDI functions.  Eligibility workflows help identify response types and route them to ETM views to work.  ETM status is used to tell whether the request is sent or the response received.  EDI claim status is now part of the BAR insurance follow-up flows and provide claim acknowledgements and status updates.  Additional BAR workflows include Prepayment Allocations, Credit Card/Recurring Payments for patients on budget plans, and Self-Pay Statement Edits.  The Underpayments module is integrated with the Payer Contract Module (PCM) to make it a more effective tool. 

 ETM continues to grow and develop innovative ways to streamline billing and collections.  Eligibility workflows open the door to front-end processes that can be used in a centralized scheduling/registration department or at patient check-in.  Through the routing of tasks to the proper place at the appropriate time, combined with providing the tools needed to work the task, ETM could expand into other areas of the healthcare continuum. 



Interim Leader: Tips for Successful Selection and On-Boarding

The evaluation of an interim leader candidate should include meeting the person either face-to-face or via conference call or Skype. Compare the candidate’s skills to those required in the statement of work. First, for example, determine if completion of a formal education is required. Look for relevant accomplishments listed on the candidate’s resume or Linked In profile. These might include achievements such as:

  • demonstrated success in a “turnaround” initiative,
  • the creation of a new practice program,
  • strong written and verbal skills,
  • experience with practice operations,
  • a successful technology implementation,
  • revenue  cycle optimization, or
  • LEAN or project management.  

 Interim leaders typically are senior level consultants with 15+ years of experience in a related role (e.g., medical practice, hospital administration, or practice management). Seek individuals active in their profession and who have advanced certification. Certification usually ensures the professional is up-to-date in his or her field.

Successful on-boarding for an interim leader is not dissimilar to that of a permanent staff member. The plan should include a general announcement to all the relevant staff and coordination of one-on-one meetings should be set up with managers, physicians, and other key stakeholders. Explain any circumstances and share relevant data regarding any potentially volatile or sensitive issues.

 Solid partnerships, smooth transitions

 With an experienced interim leader in place, a group practice has time to identify the skills needed of a permanent replacement. It can thoroughly research the labor market and compensation ranges, network with recruiters or professional colleagues, and list the job with professional trade organizations. An interim leader can help recruit the full-time manager and provide a valuable knowledge transfer to help in the on-boarding process. 

 From the beginning to the end, a strong partnership between an interim leader and a group practice will result in a successful engagement—for the healthcare professional and practice alike. 





Andrew Baker Joins Culbert Healthcare Solutions-VP of Business Development


Webinar: Epic Optimization -Jaffer Traish-January 17th 12:30 EST

Join Jaffer Traish, Epic Practice Director at Culbert Healthcare Solutions on Friday, January 17th at 12:30 pm Eastern for an insightful look into the challenges and opportunities with Epic Optimization as he shares his knowledge of best practices and areas of focus. 

This one hour online webinar will discuss the following: 

• Clinical governance, workflow and adoption improvement 
• Revenue cycle optimization 
• Patient access centralization 
• Business intelligence development 

Date: Friday, January 17, 2013 

Time: 12:30 – 1:30 EST 

Space is limited, reserve your spot today! 


Engaging a Strong Interim Leader: Why it’s Important

In today’s challenging healthcare environment, group practices increasingly are leveraging new tools to achieve success. However, many are finding that they do not have the internal resources necessary to foster the desired changes.

Appointing an interim leader is one way group practices can acquire vital expertise, especially if they have been unsuccessful during previous attempts at change management.  By bringing an outside expert on-site to assess the situation, develop and implement a process improvement plan, and serve as team manager, practices gain distinct advantages.

In any change management situation, it is essential for the group practice to develop a partnership with the interim leader. Together they should create the goals and objectives, as well as discuss the assessment and strategy.

 Expect a weekly written report that includes activities for the week, percent completion toward the goal, expected completion dates, and a roadmap of the work being accomplished is recommended.  Face-to-face meetings should be used to probe obstacles and develop corrective actions and solutions.  

 Integral to the entire process is an exit strategy that must be taken into consideration throughout the engagement.

 The advantages of interim leadership

 There are two scenarios in which an interim leader is most helpful. The first is when an unexpected opening occurs within an organization. The second is a so-called “turnaround” engagement.

 In the case of a sudden opening, the goal would be to maintain current initiatives while meeting with staff, managers, leadership and physicians. It is important in these situations to effectively gauge the mindset of the affected department, ensure a positive attitude and assemble documentation to train a permanent manager. Practices can use the time to rebuild confidence, improve staff competencies, optimize workflows, improve communication and offer transparency, which can build trust.

By contrast, an example of a “turnaround” engagement might be the oversight of one clinical department or the entire group practice. An Interim Leader can provide expertise to an organization which has been unsuccessful in meeting the changing demands; sometimes after multiple attempts.   Interims are used at the Manager, Director and the C-Suite levelsThe scope of the job is varied based on the task at hand.  It could include a review of the entire patient cycle from the point of scheduling to claim adjudication, an assessment of the IT infrastructure or to develop recommendations for re-structuring the leadership team.

In the case of overseeing a department or a division, the interim leader will assess the current state of the practice. Based on discussions with staff and physicians, observations, and review of written materials, the leader will document the existing workflows, obstacles and operations within the practice. This observation and verification is integral to the process and cannot be ignored, because even small changes in a workflow can result in an unintended impact.

 The well-documented observation of an interim leader offers a platform from which to recommend new, more efficient and effective workflows designed to improve metrics and the patient experience.

 Another important step is an open and honest assessment of all practice managers and staff. The objective perspective of interim leaders allows them to observe staff, review job requirements and competencies, and make tough decisions. Once an interim manager has completed this step, the permanent manager can start with a “clean slate.”

 Effective listening, transparency and honesty are necessary to build trust and a positive attitude—especially in the case of failed attempts at change management.   The job of the interim leader is to serve as a champion for change, encouraging long-term skill-building, knowledge development, teamwork, independent thinking and enthusiasm within the team. 

 Upon completion of the assessment, a succinct presentation of the results should be given to leadership and physicians. A summary of identified issues and a corrective action plan should be offered prior to implementation. Once the leadership team confirms its support for the plan, they can turn their attention to the staff. 

 A full staff meeting to discuss workflow changes, obstacle elimination, and new expectations regarding behaviors and achievements should be planned.   The Interim Leader can provide the leadership in making the changes assist with identifying a replacement and transition the permanent replacement. This process offers the new manager a “fresh start.”