The Epic Charge Router is one of the most robust pieces of charging functionality within the Epic EMR platform. It can singlehandedly create new charges, delete unnecessary charges, and update any item of the charge records it pleases. On the surface the charge router seems like a tool to solve all complex issues derived from your integrated revenue integrity team.
Last week The Wilshire Group brought you the three core guiding principles for knowing when to automate the charge router. Today, we bring you part two of our three-part charge router series; how to automate the charge router.
Once the decision is made to utilize the Epic Charge Router, you must then follow the appropriate guiding principles for completing the build. If not, you risk overriding current router build or creating inaccurate build.
Determine Router Placement
The Wilshire Group’s first guiding principle for automating the charge router is determining the appropriate placement for your build within the charge router. The Epic Charge Router operates from the top down, meaning each router task is reviewed, in order, starting at the top. The charge will evaluate against each task unless it qualifies for an abort action, which promptly ends the charge session in the router. After the session is aborted or has successfully evaluated every possible task, the charge session is then evaluated against charge router review workqueues.
Abort actions are important because if your build is placed underneath the abort action, there is potential your charge session will not reach your build. The abort action is most commonly used in two instances. The first instance is to stop charge conversion charges from evaluating against the entire router by placing a task at the very top of the router. The second instance is to stop Hospital Billing charges from evaluating against Professional Billing specific-logic. Outside of these situations, running into the abort action is relatively uncommon.
In addition to abort actions, the router is typically designed with Hospital Billing specific or shared (HB & PB) build coming first followed by Professional Billing-specific build. The abort action and task discussed above will identify where HB/shared build stops and PB build begins.
With these two build concepts in mind, you should use the following rules to help you determine appropriate router placement:
- Place build in the appropriate section - If you place hospital billing-specific build in the professional billing section, your build will not be evaluated. This is something we see often with clients beginning their implementation process. It’s common when designing new build to automatically assume it should go at the bottom. Within Epic, there is much more to it than that.
- Ensure build will not be negatively impacted by abort tasks - This means you need to understand the rules within the abort task and action to determine if the charge sessions you are trying to capture will be impacted. If so, place above the abort task.
- Place your build above other items that could interfere with the charge session - Incorrect task location is the most common issue we see. One of our customers had a unique situation which required them to use a modifier to define cost center assignment. The modifier was being added within the router. For this same situation, there was logic in place to auto assign the cost center if no modifier was on the charge session. Unfortunately, the build to auto assign cost center was placed above the modifier build. This resulted in all charge sessions getting the default cost center in the router instead of going through the appropriate steps. Although this is a fixable issue, it is something that can be avoided by reviewing other build in the router prior.
The Wilshire Group’s second guiding principle is to build simply. As with all build in Epic, you want to avoid complex build if there is a simpler way in the Epic Charge Router. This will help you with current testing, ongoing maintenance, and future build design.
The key here is to find a unique indicator of the charge sessions you are looking to target. For example, if you want to target all supply charges from a department, you could list every supply charge within the rule and the department from which they are triggered. In this scenario, any new supply added to the department will need to be added to the charger router rule.
The better, more efficient option, however, is to identify if those charges have the same billing category then use that billing category and the department as the unique indicators. In this scenario, you just need to create the charge like normal and give it the supply billing category. It will automatically fit within the existing logic. By Doing this, you not only make the build simpler, but you make maintenance easier too.
The Wilshire Group’s third guiding principle is to always regression test. Likely you already know this, but it’s a fundamental piece of building that still gets missed. It’s obvious to test and ensure your build works, charge sessions qualify for the rules, and the actions work as expected, but what about the inverse? With the Epic Charge Router being so robust, not testing the inverse could result in big issues down the line.
You could have built the rule with incorrect logic and your charge session qualified, but what about the opposite scenario? Have you ensured that the opposite scenario doesn’t qualify? Occasionally, there will be items within rule build that don’t work as you may expect. They may qualify everything. While your scenario may work well, this incorrect logic in the rule could be causing inappropriate charge sessions to qualify too, subsequently impacting others build negatively.
When it comes to the Epic Charge Router, teams cannot afford to make mistakes consistently . Not only does it take time to clean up mistakes and retroactively fix past mistakes, but it could have a negative impact on your bottom line.
These three guiding principles on router build, along with The Wilshire Group’s three guiding principles from last week (e.g. when to build in the router), will help your team understand the key steps to take to ensure a successful build in the router. If you have questions or if your team continues to struggle with their approach to implementing and building in the Epic Charge Router, our team of experts at The Wilshire Group can help you develop the necessary processes and steps to get your router in great condition. Next week we will be highlighting our guiding principles for maintaining the charge router post implementation in part three of our three-part charge router series.
For more information on how we can help your Revenue Integrity team, please reach out to Gretchen Case (email@example.com), Nick Freund (firstname.lastname@example.org), and Ryan Sommers (email@example.com).