Epic’s Revenue Guardian

Revenue Cycle leaders return home from Epic’s campus this week with a few new tricks in their bags.  One highlight and quickly becoming a hot topic is Epic’s Revenue Guardian.  While Epic has the charge router, front and back-end automation and workqueues abound, the Revenue Guardian is a secondary check of the system to prevent lost revenue, missing charges, and target areas you know your organization needs to keep a close eye on.  (Epic also announced a new Payment Guardian expected soon.)

Simple examples Epic offers are checking contrast orders to ensure there is a contrast charge, missing observation charges, or even missing rev 391 rev codes.  Epic uses the best practice advisory functionality many organizations are familiar with to accomplish these checks.  As of a few weeks ago, there were 25 examples in Epic’s foundation system, though now we have over 100 pre-built examples to take advantage of.  Requirements to implement are to have Epic’s HB module as well as either EpicCare Ambulatory or Epic Inpatient.  Revenue Guardian checks are only for hospital accounts and hospital billing charges at this time.  While you can configure these checks to trigger a DNB, this should be carefully discussed with your revenue integrity lead and team.

Reports, workqueues and other data can be produced from these checks, with the goal of eliminating revenue leakage and improving front and back-end training where missing charges can be automated or corrected by workflow.   Putting the appropriate governance into play to support the check findings is essential to turning the data into action.  Culbert works with organizations from design, build, and revenue integrity optimization with these checks.

Director Epic Practice

Leave a Reply