Overview

Epic Healthcare Software is a preferred choice among hundreds of healthcare organizations in the USA. It also holds an impressive market share in the US EHR market. While it undeniably ensures efficient workflows and provides robust features to support patient care, let’s be realistic: between overflowing patient schedules and the demands of top-notch care, who has time to become an Epic billing and RCM expert?

Here’s the not-so-secret truth: the complexities of Epic’s billing system can silently steal precious time and revenue from your practice. Denied claims, delayed reimbursements, and hidden coding errors can lurk beneath the surface, creating a hidden beast that eats away at your bottom line. This doesn’t have to be your reality. There’s a solution, and it’s not about giving up on Epic’s amazing capabilities. By seeking professional assistance, you can effectively manage your Epic RCM and billing while purely focusing on patient care. Discover the challenges faced with Epic billing and RCM and how outsourcing can provide a solution.

1- Encounter Documentation and Coding: A Challenge of Granularity within Epic Software

Challenge:

Epic healthcare software offers pre-populated templates to expedite documentation, but capturing the complete patient picture with the necessary detail and precision can be time-consuming. Busy physicians might rely heavily on these templates, unintentionally omitting crucial details or selecting generic options that need more specificity for accurate coding within Epic. This lack of granular detail can have a ripple effect throughout the revenue cycle.

What Impact Can It Have on Your Practice?

Inaccurate coding due to missing details within Epic healthcare software can snowball into denied claims and reimbursement delays. This not only frustrates patients facing potential out-of-pocket cost increases and treatment delays but also impacts your practice’s financial health.

How Experts Can Help?

Thankfully, Epic facilitates outsourcing coding reviews. Dedicated coders, trained as Epic’s data detectives, can meticulously analyze encounter notes within the software. They can identify any ambiguities and proactively clarify them directly with physicians. This collaborative approach ensures accurate code selection for maximized reimbursement, keeping both patients and the practice financially healthy.

2- Right Code Review and Selection: Resolving the Coding Labyrinth

Challenge:

Epic healthcare software offers a vast library of codes, but tackling the complexities of constantly updating ICD-10-CM and CPT coding systems within the software can be overwhelming. Keeping current with these ever-evolving systems requires ongoing education and expertise, which is a significant burden for in-house staff while they are already dealing with patient care tasks. Even with Epic’s update notifications, interpreting and applying these changes accurately within the software can be time-consuming.

How It Impacts Your Revenue?

This lack of dedicated time and expertise to stay current with coding updates can lead to inaccurate code selection within Epic Software Healthcare. Inaccurate codes underestimate the complexity of services provided, resulting in lost revenue for the practice.

How Professional Can Help Here?

You can hire a team of certified professional coders like those at Transcure. A team of certified coders acts as your guide within the coding labyrinth. These experts stay up-to-date on the latest ICD-10-CM and CPT updates. They leverage their knowledge to meticulously select the most specific and accurate codes for each service provided within Epic, maximizing revenue capture for your practice.

3- Charge Capture and Modifier Assignment: Decoding the Maze Within Epic

Challenge:

Epic healthcare software simplifies charge capture with pre-populated charges based on configured fee schedules. However, dealing with Epic’s time-consuming fee schedules can be a challenge for busy providers. These schedules consider factors like service category, geographical adjustments, and payer contracts. Deciphering these nuances requires in-depth knowledge that providers might lack. This can lead to inaccurate charge capture within Epic, potentially undervaluing the services provided.

How It Impacts Your Revenue Capture:

Inaccurate charge capture within Epic healthcare software can negatively impact a practice’s financial health. The practice might miss out on rightful reimbursement in two ways: under-coding services (selecting codes that underestimate the complexity) and incorrect coding (selecting inaccurate codes that don’t reflect the services provided). This can lead to denied claims and lost revenue.

How Outsourcing Professionals Can Provide Solutions?

Outsourcing medical billing and RCM within your Epic healthcare software offers a solution. Professional partners help you through the complex fee schedules in Epic. Their deep understanding of fee schedules allows them to ensure accurate charge capture that reflects the actual value of services provided. This includes considering factors like laterality (e.g., left vs. right knee examination) and applying appropriate modifiers within Epic to depict procedure complexity.

Proper billing within Epic healthcare software ensures the practice receives appropriate compensation for services rendered. This financial stability allows the practice to maintain quality patient care.

4- Claim Creation and Submission: Walking Through the Epic Claim Minefield

Challenge:

While Epic healthcare software facilitates electronic claim submission, even minor errors can create a roadblock. Errors like typos in patient information, missing diagnosis codes, or incorrect date formats within Epic can trigger claim denials or delays from insurance companies. Manually reviewing a large volume of claims for accuracy can be a tedious and time-consuming process for your RCM staff, potentially leading to errors slipping through the cracks.

How Badly Can It Impact Your Revenue Cycle?

Inaccurate claim creation and submission within Epic healthcare software can significantly disrupt a practice’s revenue cycle. Denied claims due to errors require rework and could potentially lead to lost revenue. Even minor reimbursement delays caused by these errors can strain the practice’s cash flow, impacting its ability to operate efficiently.

How Can Employing Epic Professionals Help Avoid Denials?

Outsourcing your epic medical billing and RCM offers a solution. Partners act as your claim-scrubbing specialists within Epic healthcare software. They leverage advanced claim scrubbing tools integrated with the software. These tools proactively analyze claims for potential errors, including coding inconsistencies, missing information, and formatting issues. This identifies and corrects errors before submission and minimizes the risk of denials and delays.

Faster reimbursements achieved through accurate claim creation and submission within Epic healthcare software ensure a healthy cash flow for your practice. This financial stability allows them to focus on what matters most – providing high-quality patient care without the burden of financial strain.

5- Claim Status Monitoring and Follow-Up: Cracking the Denial Code in Epic

Challenge:

Epic healthcare software provides claim status updates, but deciphering complex denial messages from insurance companies can be a puzzle for your in-house staff. Identifying the root cause within Epic often requires extensive knowledge of medical billing regulations and payer-specific policies. Your RCM staff might struggle to analyze these denials efficiently, leading to wasted time and potentially missed opportunities for reimbursement. Crafting compelling appeals within Epic to overturn denials can be another hurdle, as it requires strong communication and persuasive writing skills.

How It Impacts Your Revenue Capture?

Unresolved claim denials within Epic healthcare software represent lost revenue for your practice. Without proper investigation and appeals, the practice might miss out on rightful reimbursements, impacting their financial stability. This can create a domino effect, potentially limiting the practice’s ability to invest in necessary resources and staff training, ultimately affecting the quality of care provided to patients.

How Does Outsourcing Propose a Solution to This Problem?

Dedicated denial management specialists act as your codebreakers within your Epic healthcare software. They possess expertise in simplifying complex denial messages and identifying the root cause within the system. This allows them to focus on crafting effective appeals that address the specific reasons for denial. By leveraging their knowledge and communication skills, they maximize the practice’s chances of securing reimbursement within Epic. Recovering denied claims through effective follow-up within Epic Systems healthcare software ensures the practice receives appropriate payment for services rendered.

6- Payment Posting and Reconciliation

Challenge:

Epic streamlines payment posting, but decoding the difficulties of various payment arrangements within the software can be like untangling a maze. Sorting through a multitude of deductibles, co-pays, and payer contracts requires meticulous attention to detail. Accurately posting each component of a payment necessitates a deep understanding of the complex rules and regulations set forth by different insurance companies. Additionally, tracking and applying adjustments from insurance companies within Epic healthcare software demands a keen eye to ensure nothing goes unnoticed. Who has that much time when patient care requires 100% attention?

How Does This Challenge Impact Your Practice?

Inaccurate payment posting within Epic can lead to lost revenue for the practice. Missed or misplaced postings, even for seemingly small amounts, can accumulate over time. Additionally, failing to account for adjustments from insurance companies can also result in the practice accepting less than what they are rightfully owed. This financial oversight can strain the practice’s cash flow and limit their ability to invest in resources and staff training needed to deliver high-quality patient care.

How Can Professionals Help Provide a Solution to This Problem?

Outsourcing medical billing and RCM equips you with dedicated payment posting specialists. These specialists act as your guides within Epic’s payment system. Their meticulous attention to detail ensures accurate posting of each payment component, including deductibles, co-pays, and adjustments from various payers. By leveraging their expertise in handling complex contracts and applying adjustments within Epic, they maximize the revenue captured by the practice. Accurate payment posting within Epic healthcare software ensures the practice receives all the funds they are due.

7- Reporting and Analytics: Unveiling the Hidden Gems in Epic’s Data

Challenge:

Data analysis within Epic’s vast platform is the most common challenge faced by the in-house staff in any medical practice. Epic generates a wealth of data through its reports, but extracting actionable insights can be like searching for hidden gems in a vast mine. Your RCM staff, often pressed for time, might lack the data analysis expertise to fully unveil the potential stats of this information. Manually sifting through reports to identify trends in coding, denial patterns, or billing discrepancies can be a tedious and time-consuming process.

How Does This Problem Impact on Your Practice’s Efficiency?

Failing to glean valuable insights from Epic’s data can hinder the practice’s ability to optimize workflows and RCM strategies. Without a clear understanding of coding trends or denial patterns, inefficiencies might persist undetected. This can lead to wasted resources, unnecessary claim denials, and, ultimately, a less efficient practice.

How Can Hiring Epic Data Analysis Experts Provide a Solution?

Hiring Epic specialized medical billing and RCM services equips you with data analytics experts. These specialists act as your data detectives within your Epic healthcare software. They wield advanced data analysis tools to dissect the wealth of information generated by the software meticulously. By analyzing trends in coding and denials, they uncover hidden gems within the data, providing actionable insights for your practice’s improvement. Data-driven insights gleaned from Epic empower the practice to identify areas for improvement. This might involve streamlining billing processes to reduce errors, focusing on reducing claim denials, or optimizing staffing based on patient flow patterns.

Why You Should Choose Transcure to Outsource Your Epic EMR Software?

Transcure has epic healthcare software experts who ensure flawless coding, maximized reimbursements, and automated workflows for your practice while you focus on patient care. Here’s what our experts offer:

• Encounter Documentation and Coding Experts: Our 1100+ certified coders ensure accurate code selection by meticulously reviewing encounter notes within Epic.

• Right Code Review and Selection: We stay updated on the latest code updates within Epic to maximize revenue capture for each service provided. 

• Charge Capture and Modifier Assignment: Our professionals ensure accurate charge capture within Epic to reflect the true value of services provided. This helps providers get their deserved reimbursements. 

• Claim Creation and Submission: With advanced tools within Epic, we proactively analyze claims for errors to ensure faster reimbursements. 

• Claim Status Monitoring and Follow-Up: Our denial management specialists identify the root causes of denials and craft effective appeals for reimbursement within your Epic Healthcare.

• Payment Posting and Reconciliation: We ensure accurate posting of each payment component within Epic to increase revenue capture and maintain a healthy cash flow. 

• Reporting and Analytics: Our data analytics experts dissect Epic’s data to provide actionable insights for optimizing workflows and RCM strategies within the platform. We also provide daily payment posting reports so you can keep up with your revenue cycle status.

• AR Management with Epic: We specialize in getting you paid faster using our in-depth knowledge of AR Management with Epic. We can streamline the collection process, speed up payments, and maximize the money you’re owed—all within your own Epic.

Partner with Transcure today to leverage our expertise within Epic and increase revenue capture, reduce denials, and maintain financial stability in your practice.

The Perks You Get by Joining Transcure

• 98% First-Pass Clean Claims Rate with Your Epic Software.
• Proven Track Record of Over $500 Million Claims Processed.
• 48-Hour Turnaround Time & Faster Reimbursements For a Healthier Cash Flow.
• 30% Reduction in Accounts Receivable.

Don’t let Epic’s billing burden slow you down. Transcure is here to help you achieve peak financial health.

To Sum It Up

Epic healthcare software offers robust features for patient care, but its billing system can be a challenge. Understanding the complexities of RCM within Epic and exploring outsourcing solutions can empower your practice. Outsourcing with expert companies like Transcure can offer a multitude of benefits, such as accurate coding and billing, faster reimbursements, reduced denials, improved cash flow, and data-driven insights. By letting experts handle the complexities of Epic billing, you can focus on providing exceptional patient care and achieving peak financial health for your practice.

Frequently Asked Questions (FAQ’s)

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