Charge/Revenue Integrity Department Structure in Epic Organization
Hello,
My organization recently began a two-year conversion from our current EMR/billing systems to Epic EMR and billing. I am the director of our Charge Integrity Department (includes CDM, charge auditing, charge reconciliation) and I'm curious to learn from others who've made the conversion to Epic what worked, what could have gone better, etc. I'm also curious to learn more about how Charge/Revenue Integrity Departments are structured in Epic Organizations (e.g., what roles do you have, what work do you do, size of department, etc). Thanks in advance for any information you can share!
Mary
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Great question Mary, curious to see some responses as we're also in transition.
I've been on the side of an Epic hospital acquiring a non-Epic hospital, and transitioning them. Biggest thing is making sure that you're comparing apples to apples as much as possible. For example, if you're charging meds on dispense in your system, and on admin in the new, you're probably going to see differences in your reconciliation that aren't necessarily errors, just differences.
Making sure clinical staff and leaders know who to go to about their charges, and making sure you know who in IT can help with which issues is also important.
We had meetings with Epic TS, IT, RI, and clinical leaders to go over reconciliation reports on a daily basis for the first few weeks. Clinical leaders were asked to save the time, but they were only required to go if their area was called out in the reports.
Have a spreadsheet or some other documentation of the different departments and their charging methods, if you went with foundation or otherwise. Make sure you're aware of any interface WQs where things may be caught, some can/should be worked by IT, some by RI, that just depends on your structure. Even if we can't fix it we like to know what's going on.
For structure I'm pretty sure there's a few examples on the main NAHRI site under "member resources". I'd say it can and should vary significantly based on the size of your organization, and how the organization is structured: one big hospital, big hospital with some smaller procedural facilities, large number of hospital outpatient departments, no off-site outpatient departments... as well as the responsibilities of your HIM group, if they review all diagnoses, or just IP/OBS, that sort of thing.