Why Do Providers Require Professional Assistance with Medical Billing in Epic Healthcare Software?


Epic healthcare software is a leading choice for hundreds of healthcare organizations across the USA, holding a significant share of the US EHR market. While it excels in ensuring efficient workflows and robust features to support patient care, the reality is that the demands of patient schedules and top-notch care leave little time for providers to become Epic billing and RCM experts.

The complexities of Epic’s billing system can quietly drain your practice’s time and revenue. Issues such as denied claims, delayed reimbursements, and hidden coding errors can undermine your financial performance. However, this doesn’t have to be the case. The solution isn’t about abandoning Epic’s powerful capabilities but rather about leveraging professional assistance to manage your Epic RCM and billing effectively. This way, you can concentrate fully on patient care.

Explore the challenges associated with Epic billing and RCM, and learn how outsourcing can provide an effective solution.

1- Encounter Documentation and Coding


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


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 Claims BPO. 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


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


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


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.

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