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Charge Reconciliation: A Long-Term Commitment

Performing Charge Reconciliation is critical for ensuring financial success and stability immediately following Go-Live, but it shouldn’t stop upon reaching an initial stabilization period.  Departmental Charge Reconciliation needs to become an expectation and the new norm for monitoring revenue success.  You worked long and hard to mold a new culture following your EMR transition, maintain that culture and be rewarded.

As you become further removed from the introduction of a new system, it becomes easier to lose sight of the critical processes which helped you successfully navigate that important time.  Revenue focus slowly shifts away from individual departments, cost centers, and bill areas. You may experience staff turnover, the reporting tools turn stale, and processes become lax, all contributing to a shift toward ineffective processes. 

Now more than ever, it is critical to maintain that reconciliation culture you spent so much effort building.  Important factors that contribute to successful reconciliation include:

  • Leadership Buy-In: charge and revenue reconciliation owners need to feel their contributions are necessary and valued by the organization rather than just an administrative requirement.
  • Support Structure: a strong network of Revenue Integrity and IT support resources ensures that department concerns are addressed, and issue/charge investigation is done in a timely manner.  
  • Reports & Insights: all parties involved in charge reconciliation should have access to current charge reports along with the ability dive into full clinical chart history for investigation when needed.

As your organization matures on a new system, new tools gain value. Data in the system grows, requiring new reporting mechanisms in order to demonstrate meaningful results. Upgrades are embedded with fancy new tools - they can be difficult to visualize, configure, and understand ahead of time. Often individual charge reconcilers, and even organizations as a whole are unaware of the best reporting mechanisms currently available.

Don’t sleep on reconciliation and processes.  Your EMR is an evolving tool, ever-changing and improving in the world of updates, upgrades, flow sheets, smart-forms, charge navigators, CDM and fee schedule maintenance, and more.  With constant system changes, ongoing reconciliation remains critical - the tools and processes need to evolve alongside the rest of your organization.  Communication of changes, and recognition of proper tool access are keys to ensuring success.  Repetition breeds success in the world of charge reconciliation and revenue integrity.

If you have concerns about your reconciliation processes and tools, or are experiencing difficulties with revenue leakage or revenue integrity, The Wilshire Group is here to assist.  We have helped many clients navigate these tough times and can work with you to get the most out of your people and technology. We'd love the chance to help put you on the path toward long-term financial stability.