How to do it... EMR and billing integration

1. With the emergence of bundled care, capitated rates and accountable care organizations, there's never been a more critical time to integrate. 

“As providers wrestle with the demands of health information exchange, new rules for focused survey and the IMPACT Law, there is little bandwidth to spend on managing disparate billing and clinical systems,” says Kirby Cunningham, RN, vice president of Strategic Clinical Initiatives at AOD Software. 

2. Integration efforts require diligence and homework. Separate systems that simply play nice aren't integrated.

“A software interface is a bridge that allows two software systems to share information with each other,” says Doron Gutkind, chief software architect at Lintech. “Software integration requires multiple software modules working as one solution. Instead of passing information between systems over a bridge, the modules share the same code and database.” 

Other considerations, according to Amy Ostrem, senior product manager, revenue cycle management at MatrixCare, include understanding how “real time” the integration will be and the effectiveness and competency of your client services team.

Computerized physician order entry is essential, says Sitella Smith, SigmaCare's director of marketing.

“The clinical workflow starts with the physician orders so robust CPOE functionality is critical to the success of billing,” she adds.

3. When possible, automate data input. Automated retroactive resident billing changes avoid deadline snafus and uncollected co-pays, says Robert C. Davis, CEO of Optimus EMR Inc.

MDS assessment information must flow seamlessly from clinical to billing, including RUG-IV score, HIPPS code, assessment reference date and from-and-through dates, adds Cindy Hartman, product manager, NTT DATA Long Term Care Solutions.  

Built-in checkpoints help ensure accurate and timely data, says Lorraine Lodigiani, product manager, financial, American HealthTech.

4. Ensure data used by both systems comes from a common source. 

“The integration of AR/billing and clinical systems can occur successfully when the shared data has an established ‘single version of the truth' rule set from the outset of the project,” cautions Maria D. Moen, vice president of care innovation at VorroHealth. 

Common data sources include payor, admit, transfer and discharge information, adds Hartman. Other elements are ADT records and MDS scheduling, Davis adds.

5. Exploiting cloud-based systems can ensure the integrity of your system in the event of a disaster. In addition, consider such features as automated Medicare/Medicaid rate updates and MDS schedules.

Doug Fullaway, vice president of Senior Living Business Development at ` Senior Living, advises providers to fully integrate their billing systems with electronic payment systems. Real-time, automated eligibility verification is a must too, Lodigiani says.

6. Ensure the solution allows customization. 

“Effective integration should reflect the ebb and flow of information that occurs as treatment is being rendered and accounted for,” says Moen. 

Easy-to-use, modifiable modules that perform such tasks as calculating amounts due are always a plus, says Fullaway.

Consider features that allow free-text attachments, which provide a valuable narrative form from billing to the EMR, Lodigiani says.

7. The best integration is useless unless a facility stays true to its core clinical mission. 

“The bridge between the medical record and billing is secondary to having a good EMR that is focused on the patient in the first place, because the purpose of the nursing home business is patient care,” says John E. Ederer, N.H.A., president of American Data.