Why Your Billing Breaks at Location Three: Scaling Medical Billing Across Cloud EHR Workflows

A second location can often seem like an easily executed step. Your current billing still exists and staff understand their role and there is relatively good financial reporting. With location three, things always change because there are so many more providers, patients, payers, charges and workflows that increase the opportunities for billing problems. One office may document differently, another may enter the charges late, and yet another may employ various documentation formats or coding. These disparities introduce revenue cycle hurdles that grow more difficult to pinpoint as the practice expands.

Cloud based EHR software is the use of technology to unilaterally establish a foundation of multi professional practices. While technology is certainly part of the answer to disorganized billing functions, it’s not the only solution. The work flow, monitoring and accounting for data, as well as standardizing the income cycles are other parts of your standard work that are important to standardize. If your business plans to expand beyond three storefronts, then you will need a scalable billing system.

What Actually Breaks When You Add Location Three?

Most of the time, the trouble with this issue is triggered prior to a claim being sent to the payer. In a growing practice, it is usual for the number of locations to outpace the number of standardised administrative procedures. What happens in each office and the individual practices become a habit and it is only a matter of time that it impacts claims, payments, denials, and accounts receivable.

Patient and Insurance Data Becomes Inconsistent

Accurate patient and insurance information are essential for every billing process. If different sites enter data in different ways, the chances of finding inconsistencies decrease. Subscriber data may be recorded properly at one point and not at another for the one. Any information with regard to insurance could be updated in a single workflow and not in another. Errors that impact eligibility verification and claim submission.

A cloud based EHR software makes it easy for authorized teams to access patient data from anywhere. With a core data source, duplicate patient records are easier to manage too. There is, however, still a need for having a standard registration and verification process for your organization so that each location adopts the same process.

Charge Capture Starts Varying by Location

The more providers and locations grow more difficult to control, the more controls will be necessary to capture charge. The charge entry process may be executed on a daily basis at one office and on multiple day intervals at the other office. Some service providers may record services uniformly, others may not leave the information in a way that is easily clarified. These differences result in charge lag, impacting submitted claims and reimbursement.

Integrated billing function data provided by cloud based EHR software enables billing staff to have a holistic view of charge data throughout the organization. There’s still a need for standardized charge capture workflows across your organization so everyone at every location performs the same procedures for capturing charges and submitting billable services. Your billing team should also be tracking charge lag by location to identify workflow issues that may be occurring and be leveraging that data to inform the business about because it will alert management to the fact that there is a problem.

Payer Rules Become Harder to Control

Each location can have a different payer mix which makes it more challenging to manage payer requirements across multiple locations. Providers could also have distinct enrollment standing, contracts or credentialing needs. Information regarding the location and providers should be current for claims made.

With cloud based EHR software it’s possible to keep information about providers and locations consistent in a shared system. But rejection or denial can also happen for an incorrect billing provider, service location, payer configuration, authorization detail or claim element. To avoid problems with your configuration you need to review your payers and enrollments on a regular basis though, for your billing operation.

Management Loses a Single Financial View

Having visibility at two levels is necessary for multi-location practices. For leadership, they need an overview of the financial performance of the organization and for managers they need data at the location level to detect and solve operational issues. These opinions are hard to sustain when there’s no consistent reporting. With a consistent data and workflow standard, cloud based EHR software can allow for easy centralized reporting. Different offices could report different denial percentages or can have different numbers in the different spreadsheets. Your leadership team then runs into the time lag of reconciling and addressing revenue cycle issues rather than solving problems.

Why Cloud Based EHR Software Matters for Multi-Location Billing

Cloud based EHR software presents the central place where doctors and administrative solutions can get to clinical and administrative details. This is important for an expanding practice since billing relies on data collection across the patient journey. Registration has an impact on eligibility, documentation has an impact on coding and coding has an impact on claims and claims on reimbursement and reimbursement on A/R.

Errors can be missed if these processes are not conducted in one piece and not used consistently. In a cloud environment you have to: Have centralized access to information and workflows across locations with the technology, but right users, governance, training and billing control.

Centralized Patient and Practice Data

Core information is important for practice use and access must be consistent across multiple locations. This includes:

• Patient demographics
• Insurance information
• Provider information
• Location details
• Clinical documentation
• Diagnoses
• Procedures
• Billing information

Cloud based EHR Software minimizes redundant information entry by providing customers with records and practice data that are centralized and accessible by authorized stakeholders. Its goal isn’t just to put everything in one. To ensure accurate information flowing through the billing process, your practice should establish uniform data standards in all locations.

Standardized Billing Workflows Across Locations

The underlying principles of your billing should be the same, no matter where the claim comes from: location 1 or location 5. When the rules about billing and the systems are consistent, cloud based EHR software can help make these streamlined workflows easier to maintain.

Standardized workflows should cover:

• Patient registration
• Eligibility verification
• Prior authorization
• Charge capture
• Coding
• Claim preparation
• Claim submission
• Payment posting
• Denial management
• A/R follow-up
• Patient billing

Standardization increases ease of performance measurement. Consistent processes must be developed for leadership to know why things are different if one location has a 4% denial rate versus another with a 10%. If they’re not the same workflow by two teams, the numbers won’t be as useful to compare.

Remote Access for Distributed Billing Teams

Another significant benefit of cloud based ehr software is distributed billing operations, as they enable authorized groups to access shared information from a location. You may have clinical teams in multiple locations and your billing team is in one central location. Coding specialists can assist providers in various facilities and managers can do a remote review of financial performance. Having a shared system will diminish reliance on location, and ease communication between billing staff and clinical or administrative departments when information is needed. What’s missing is appropriate permissions, workflow controls and staff training.

The Billing Workflow You Need Before Opening Location Four

The use of technology should be in service to the process, not the other way around. Prior to adding another location, record your practice’s approach to each component of the revenue cycle and set up commensurate responsibilities throughout your practice.

Step 1: Standardize Patient Registration

The next step is registration and creating the data to be collected and verified at each location. Your process should have:

• Patient demographics
• Insurance information
• Subscriber details
• Member identification numbers
• Effective coverage dates
• Guarantor information
• Required authorization details

Cloud based ehr software can help organize these records, however, the accuracy of the records will depend on the manner in which staff gather and validate information. Your team should also decide how to detect duplicate patient records. Billing errors, which are likely to occur if the registration data is incorrect, are more time consuming to correct after claims are submitted than if the data were correct from the start.

Step 2: Standardize Charge Capture

Define how every location records billable services. Your process should establish responsibilities for:

• Provider documentation
• CPT codes
• HCPCS codes
• ICD-10-CM diagnoses
• Modifiers
• Units
• Place of service
• Supporting documentation

Also charge lag should be tracked by your billing personnel. If it has been determined that one location is submitting charges later than another, check for a cause. This may be documentation related to the providers, workload, design of the workload, or configuration of the system.

Step 3: Validate Claims Before Submission

Claims validation should take place prior to claims being sent to the payer. Pre-submission workflows can also be supported by cloud based EHR software that can transport pertinent patient, provider, location and billing information to a unified setting.

Review claims for common issues such as:

• Missing patient information
• Incorrect insurance data
• Coding inconsistencies
• Missing modifiers
• Provider-location mismatches
• Authorization issues
• Documentation gaps
• Incorrect payer information

Pre-subment validation can sound the positive signal of avoiding rejections and allow billing groups to mend errors before they inflict harm on reimbursement. This method also gives registering, coding and clinical personnel useful documentation in case of the same mistake occurring over and over again.

Step 4: Create Centralized Denial Work Queues

Denials are not to be limited to a single location. Establish a central system for classification and collection of denials and monitor denial codes by:

• Location
• Payer
• Provider
• Procedure
• Diagnosis
• Root cause
• Appeal status

While cloud based EHR software can provide access to billing data for all teams, ownership and follow up for denial management must be clearly established. If this is the case and one location is consistently resulting in eligibility-related denials, registration or verification may be the answer and not an increase in collections activity.

Step 5: Standardize Payment Posting and A/R Follow-Up

Payment posting also requires consistent procedures. Your team should establish processes for:

• ERA processing
• Payment reconciliation
• Contractual adjustments
• Patient balances
• Credit balances
• A/R follow-up
• Aging account review

Centralized workflow provides management with a better overview of outstanding revenue. It is still recommended to segment A/R by location, by payer, by provider and by aging category as these comparisons will help to determine where money is being stuck.

How Multi-Location EHR Workflows Prevent Revenue Leakage

Revenue leakage typically begins at the small operational level. A missed charge could be a minor incident, a delayed claim could impact one patient and a wrong insurance record could cause one rejection. If you multiply these problems by thousands of encounters, several locations, the impact is significant.

Capture Every Billable Service

Cloud based EHR software helps your organization maintain centralized information around documented services and billing activity. Your team should compare clinical activity with submitted charges when appropriate. This assists in determining if there are any discrepancies between services rendered and services billed, especially if there are different charge capture policies from different locations.

Reduce Duplicate Data Entry

The more that information is manually entered, the more chances for the information to be inconsistent. Cloud based EHR software eliminates duplication of patient or practice info when properly used by authorized practitioners. Standardized procedures also reduce the recognition of information being missing or repeated from one employee to another, and allow for easier identification of any potential errors that may occur.

Identify Location-Specific Billing Errors

You should be able to compare locations in your billing reports. If your organization’s denials are as follows, for instance:

Numbers are not sufficient to describe the problem. Your team should review the categories of denial and determine if the increased rates are due to eligibility, coding, authorization, registration, documentation, or a problem related to the payer. This is where “location-level reporting” is useful: it will relate financial performance to operational causes.

Protect Revenue During Expansion

Your billing system ought to evolve along with your increasing practice. Don’t postpone workflow review until your 4th or 5th location starts to have issues with the bills. Prior to expansion, figure out the revenues lifecycle, who should be accountable for every element of the cycle, set up a typical procedure, and stencil metrics. Then make your tech to them.

Centralized EHR Data Does Not Fix Broken Billing Processes

This is quite significant because Cloud based EHR Software does not magically end the possibility of billing errors. It is possible to have today’s technology and still have:

• Incorrect coding
• Poor documentation
• Missed charges
• Eligibility errors
• Authorization problems
• Credentialing issues
• Claim rejections
• Denials
• Delayed payment posting
• Aging A/R

Technology gives you infrastructure and your processes give you how you use that infrastructure. Your employees must also be trained accordingly and have clear roles. Managers must be reported, billing staff must have defined work queues, and providers must be given feedback when the documentation impacts coding or reimbursement. Successful multi-location billing relies on technology, process controls, and continuing RCM monitoring. This will help stop your EHR from being a new workflow system that only collects data without solving revenue related workflow issues.

What to Standardize Across Every Location

Set organization-wide clinical data, billing, revenue cycle and performance measurement standards before expanding to more locations.

Clinical and Billing Data

Every location should follow consistent rules for:

• Patient demographics
• Insurance information
• Provider identifiers
• Location identifiers
• Diagnoses
• Procedures
• Modifiers
• Documentation

Cloud based EHR software allows your organization to have a common work area to collaborate on all of these documents and requires them to all follow a standard set of data accordingly.

Revenue Cycle Processes

Standardize:

• Eligibility verification
• Prior authorization
• Charge entry
• Coding
• Claim submission
• Payment posting
• Denial management
• A/R follow-up
• Patient collections

Such workflows should be documented on your teams. Written procedures reduce a dependence on practice of each member of staff and give managers a uniformity for teaching and investigating.

Performance Metrics

Track the same important indicators at all locations. If the definitions and data structures are clearly defined and standardized throughout your organization, and the data is centralized, the cloud based ehr software can help.

Important metrics include:

• Clean claim rate
• Claim rejection rate
• Denial rate
• Days in A/R
• Net collection rate
• Charge lag
• Payment posting lag
• Aging A/R
• Collection performance

Through a common KPI system leadership can compare sites by consistently using the same KPI definitions. Also, it makes the identification of a problem, whether it’s a specific location or a specific group of payers or a specific group of providers or a workflow easier.

How to Measure Whether Your Multi-Location Billing Works

The bottom line isn’t sufficient to make your practice work. Products have a revenue that gives you your operating result and your operational measures will give you the explanation of why this is the result and what corrective action you can take.

Compare Locations Using the Same KPIs

Using the same definitions, compare each location. If one office is getting a lower denial rate, then send separate to verify that there is no discrepancy in the definition and calculation of denials between the two offices. If not, the comparison is not meaningful and can lead management to taking the wrong action and to the wrong corrective action.

Track Denials by Root Cause

Never assume that every time you’re denied that it’s a collection issue. Break denials into categories, for example:

• Eligibility
• Coding
• Authorization
• Documentation
• Registration
• Payer processing
• Timely filing

Next determine which problems reoccur. If denials are recurring, the issue may not be errors with specific claims, but rather a process problem that needs to be resolved to eliminate the errors, and to fix the issue is to fix the process.

Monitor Charge-to-Claim Lag

Track service time and delays in services completed and claims submitted. Long charge-to-claim turnaround time may lead to reimbursement delays, admin follow-up can get longer and A/R can become more time consuming. Ensure that there is a delay present at one site and research first, then further out if necessary.

Watch A/R by Location and Payer

A/R reporting should show where outstanding revenue sits. Break down A/R by:

• Location
• Payer
• Aging category
• Provider
• Balance type

This helps your group to remain focused and focused on trends of your payers or locations. Also, it helps management to know whether the rise in A/R has occurred because of a rise in the volume or poor collections.

When Should You Centralize Your Billing Operations?

The more complex operations are, the more valuable is centralization. When you have considered your billing structure, you should do so if you have:

• Three or more locations
• Multiple billing teams
• Rising denial volume
• Different workflows between offices
• Increasing A/R
• Duplicate administrative work
• Limited financial visibility
• Difficulty managing payer requirements

Centralization allows access to information from cloud based EHR software but it also needs to have consistent policies, ownership, reporting and accountability. Your clinical operations can stay location specific, but your revenue cycle can adhere to a standard structure.

How Billing Care Solutions Supports Multi-Location RCM

Just, medical billing software setup is not sufficient to scale. Billing Care Solutions is a revenue cycle solutions provider, offering medical billing and coding, medical denial management, medical A/R, medical payment posting, medical payment reporting and revenue integrity services. A multi-location business can make use of this kind of support for reporting specific billing tasks to the business.

End-to-End Revenue Cycle Support

A centralized RCM approach integrates critical patients to claims and payment stages, along with reporting. A well-structured RCM workflow ensures that every stage of the billing process is supervised, whereas cloud based EHR software gives the technological framework.

Denial Prevention and A/R Recovery

Denial management needs to be based on the root causes. The reason for claims denial should be determined by your billing staff, any patterns should be identified and a workflow solution should be developed. After that, A/R follow-up runs reports to look at balances that are outstanding as paid by, aged, doesn’t live near, and even by financial priority.

Financial Performance Analytics

Multi-location practices require reporting with a location-level breakdown as well as overall performance. Cloud based EHR software can help consolidate relevant information, while financial analytics help leadership identify trends in:

• Collections
• Denials
• A/R
• Reimbursement
• Charge volume
• Claim performance

This information will support in the making of better operational decisions as the organization grows and can guide management in where their billing resources need to be increased.

Revenue Integrity and Compliance

Coding and documentation and process compliance are also important for billing accuracy. Frequent reviews help to catch discrepancies early to avoid them being a regular billing hassle. Revenue integrity is more important for growing practices as if there is a minor process problem in one location, it can impact claims in another location.

How to Prepare Your EHR Before Adding Another Location

Don’t consider a new site as an addition. Before implementing the new facility, reviewing the current Cloud based EHR software can help consolidate relevant information, while financial analytics help leadership identify trends in: and billing systems and procedures and make sure the system, the workflow, staff responsibilities, and the reporting system are consistent with the new facility. Before expansion, Cloud based ehr software solutions ought to be assessed based on the genuine multi-location billing needs. Check to see if your system allows for consistent location configuration, centralized reporting, user access, standardized workflows, and trustworthy billing data.

Use this checklist:

1. Review your current EHR configuration.
2. Standardize location identifiers.
3. Verify provider enrollment and credentialing.
4. Review payer contracts and requirements.
5. Map the complete billing workflow.
6. Standardize coding procedures.
7. Define claim ownership and escalation paths.
8. Create centralized denial work queues.
9. Establish location-level KPIs.
10. Test financial reporting before launch.
11. Train staff on standardized workflows.
12. Audit billing performance after launch.

The last but not least step is important. Not everything works as planned in your workflow because the system is online. Follow-up early claims, rejections, denials, charge lag and A/R after a new location opens for business. You have time to correct the process problem if it happens early for something not to become a habit.

Scale the Workflow Before You Scale the Practice

Not all billing issues are caused by Location Three. Identifies abilities and areas for improvement that were likely to be missed with a smaller organization. The more locations, the more data, providers, payers, claims, charges, and administrative handoffs will exist, making complicated processes more difficult to manage. This complexity can be managed with cloud based EHR software.

It doesn’t take the place of standard billing procedures, trained personnel, correct information or solid RCM oversight. The aim should be to develop a single revenue cycle process that is applied to ALL sites. Standardize registration. Control charge capture. Validate claims. Centralize denial management. Continuously track A/R and make comparisons based on the same measurements. Next, grow that practice with a billing operation that can help it grow.

Frequently Asked Questions