Healthcare is often reactive, rather than proactive, when it comes to opportunities for improvement. It is often a race to fix what went wrong, not institute infrastructure to prevent it.

Tied to the above is the fact that EMR / EHR is a significant outlay of cash for providers for something that is not directly a medical product. EMR / EHR is not treating patients, but rather it is often something more easily interpreted as administrative as many physician offices are only focusing on capturing incentive dollars.

EMR / EHR companies are using any and every angle they can to make their product stand out above the others. Some EHR / EMR vendors are including billing software and telling providers that their EMR “software” does the billing too. They also push the fact that the EMR and the billing are “linked” to each other. They tell their prospects that they can save money by not hiring a billing service to take care of the billing and collections (Revenue Cycle Management), but anyone who is an expert in RCM knows this is just not true.

Personally, I see EMR as a totally separate entity from the billing. Having billing software does not mean it is smarter for a provider to keep the billing in-house. Actually, most providers who outsource their medical billing already have software capable of billing. The issue for most providers who choose to outsource is that they realize that they must maximize their reimbursements at every turn and they do not have experienced staff who expertly and consistently handle the billing, the claims tracking, the phone calls, the denials and appearances process, keeping up with the continuous healthcare mandate changes, the clearinghouse and electronic submissions, credentialing and they recognize that the experience that they get from outsourcing their billing and collections to a billing company is crucial to keeping the doors open. Many providers realize that they save money by outsourcing. Some have difficulty hiring, training and keeping a knowledgeable person in that position in their office.

Bottom line, no matter how good your billing software is, it is only as good as the person using it. A provider's income relies on the billing. If they do not they will lose money, no matter how good their software is and whether or not it's tied to their EMR / EHR.

Ten key features within your EMR / EHR and Practice Management solution can help the transition go more efficiently and provide you some savings.

1. Implementation – Can not be stressed enough. KNOW your needs and wants while choosing your EMR / PM solution. An EMR / EHR should enable physician practices achieve greater patient efficiency by streamlining day-to-day operations, strengthening the patient-physician experience and improving patient quality.

2. Management Commitment – With that being said, need to have providers and staff on-board for a successful transition. Perhaps this means having small but focused project team that is made up of “systems thinkers” – these are people who understand how the current organization works, but more importantly have the vision of how it could work.

3. Robust software emphasizing practice specifications – Define which billing data the practice would like to capture that is specific to your practice and / or specialty. Does the EMR convert encounter / super-bills to claims? Does it “interface” with the practice management software? If not, the process will definitely increase time and cost to the practice. The correct charge application, taxes and discounts for claims should be applied to this feature (critical for ophthalmology and optometry) practices.

4. Real-time electronic eligibility and electronic claim submission – These features should be a given in any EMR / EHR. Is the software capable of checking patient eligibility in real-time? Will the clearinghouse supply direct claim verification?

5. Robust accounting and financial reports – Report management is imperative to any billing features of an EMR / EHR

6. Electronic tracking of payments – All details should be tracked in the payment process. Features should include the ability to log and communicate every action performed in order to get a claim paid.

7. Real time claims rejection analysis – Error codes should be displayed clearly. This feature can enable users to: immediately resolve problematic claims, analyze the reasons for claims rejection and gives the practice an opportunity to monitor red flags as they arise and to implement types of audits.

8. Billing codes directly excluded from EMR / EHR – This automated feature incorporates pulling (interfacing) the E / M codes and procedures directly from the EMR / EHR documentation. By pulling patient data as it is being entered during patient history, medical notes, pathology and radiology entries, procedures and prescriptions, services rendered are recorded immediately.

Embedded Meaningful Use dashboard helps providers track progress towards meeting Meaningful Use certification.

9. Multi-User, secure and user friendly – Users should be able to utilize strong embedded claims editing solutions, claim status technology that automatically checks claims status for improvement in reimbursements, automatic claims submissions to name a few.

10. Monitoring, backups, and data recovery – Prevention is always the best measure and a system should be firmly in place for system monitoring and backups.