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Competing in an EHR-Driven Business Environment By Ron Sterling

Electronic health records (EHRs) are changing the service needs and management focus of many physician practices and healthcare organizations. These changes are being driven by Medicare and Medicaid incentives and demands from patients and healthcare providers for more timely and efficient patient management and communications.

These healthcare business environment changes pose a number of challenges and opportunities to third party billing organizations. Ignoring the evolving technology / EHR needs of your current billing clients may prevent your organization from being a part of those clients' strategies going forward.

  • Clients are examining their EHR options without considering their current medical billing solution. In the most dramatic cases, practices are making their EHR decisions and adopting the practice management system (PMS) partner of their EHR selection.
  • EHRs make technology a mission critical part of the practice. In most cases, the loss of access to the PMS will not disrupt clinical operations, but loss of the EHR system will pose a wide array of patient service problems. After a system failure, the EHR recovery process includes the difficult task of updating the EHRs to account for patient activities during the shutdown.
  • Competitors are entering the healthcare billing arena with a full panel of product and service offerings. A number of vendors now offer combined EHR / PMS solutions with integrated patient portal, clearinghouse, and even revenue cycle management (RCM) services from a single vendor.
In order to address the changing needs of current billing clients as well as attract new billing clients (who ironically may be driven by a need to modernize their own PMS and / or implement an EHR), consider the following action items:
  1. Evaluate the Billing System – The current capabilities of your billing system should be reviewed to verify that the software meets the evolving needs of physician practices and provides a good base for your EHR strategy including:
    1. Support for interfacing with the EHR system by sending demographic and appointment information to the EHR and receiving charge transactions back from the EHR. The billing system should support a vetting process for incoming charges and provide tools to quickly focus attention on problematic information in the EHRs.
    2. Automated collection tools to speed patient contact and collection efforts with email, automated phone calls, and letters. Effective collection strategies should also include patient portal collection and payment features.
    3. Flexible and graphical reporting options that provide timely reporting of charge, collection, and write-off trends. A dashboard that instantaneously displays the current financial activities and A/R details is useful to monitor activities at the front desk and from the EHR.
    4. Patient portals to facilitate interactions with patients on appointment, demographic, and billing issues. Note that the patient portal strategy should accommodate EHR issues.
    5. Support for the transaction life cycle of electronic eligibility, claim, and remittance advice transactions. For example, the PMS should be able to request electronic eligibility as well as maintain a log of eligibility responses.

  2. Develop an EHR Strategy and Expertise – At a minimum, most physician practices are facing complex organizational decisions and need a level of support that exceeds their own capabilities. Support may include software support, staff training, daily user assistance, and daily maintenance of the EHR system. Additionally, the third party billing organization may be able to act as the client advocate in analyzing and resolving problems in consultation with the EHR vendor. Note that your strategy will have to determine the level of EHR involvement, such as offering advice, general EHR consulting, hosting selected EHR solutions, supporting EHR use, or actively promoting a specific EHR product.
  3. Offer EHR Expertise – Engaging clients on EHR issues is a key activity to ensure that you are positioned to help those clients deal with EHR challenges. If clients do not recognize you as a source of EHR information, they may engage in an EHR selection process without even informing you. Based on your EHR strategy and expertise, you should actively engage clients through materials on EHRs, seminars, and – most importantly – personal contact. The fact of the matter is that a wide array of EHR vendors and other parties are bombarding medical practices with EHR "advice" and options. Your clients need advice on this dramatic change from a source that understands their practices and challenges.
The lack of expert advice on EHR selection and adoption is confusing and frustrating to many physician practices. However, EHR adoption is driving dramatic changes to physician practices, and, in many cases, changes to their billing strategies. Third party billers are in a unique position to capitalize on their established client relationships by helping them overcome the critical challenges posed by EHRs.
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