When thinking of EHRs, we usually think solely about the clinicians or the clinical elements; we are not always considering the revenue cycle management process being integrated and working harmoniously in tandem through a mutual exchange of data.In this perpetually evolving healthcare landscape, single and/or integrated platforms across ambulatory settings will be a necessity for clinical, financial, and operational data flows. In the value-based care model, payments will be now considered based on the accuracy and completeness of medical documentation of services rendered and managed by the providers.
Putting it in perspective...
When considering the clinical components for appropriate use of an EHR, a practice will benefit from this data exchange:
- Providers will be facilitated with the analytical data to ensure capture of practice procedures and financials.
- Utilizing rule engines further aid providers by suggesting clinical (and financial) activities to improve outcomes and optimize revenue by identifying appropriate procedures at the point of decision making.
- Alerts advise the user when a requested procedure or test will not be reimbursed by the payer, as well as flagging duplicative care documentation to avoid revenue loss.
- Alternative procedures or tests for which the payer adjudicates claims can be recommended over an initial, non-reimbursable choice.
- Data captured in the EHR flows directly into the RCM system to increases overall efficiency, accuracy, and accountability for the practice while mitigating risk.
- Billing and payer intelligence can be integrated into the care cycle, which we will enable a more informed focused on patient care; informed decision-making at the point of service can lead to improved clinical outcomes and health management.
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