The Wilshire Group Blog

Home | The Wilshire Group Blog | Is Revenue Guardian right for your Revenue Integrity team?

Is Revenue Guardian right for your Revenue Integrity team?

Epic’s Revenue Guardian is one of the most robust tools on the market for preventing missed revenue opportunities, reducing denials, and ultimately decreasing AR days, so why aren’t more organizations using it?

Well, the answer to that is quite simple. When implemented and used incorrectly, revenue guardian checks can have the opposite impact. Because Revenue Guardian checks function by stopping accounts for review, it can lead to a delay in sent claims, which in turn, will hurt your Candidate For Bill (CFB) and your AR.

This alone could be enough to deter more risk-averse organizations from implementing Revenue Guardian but let us be the first to tell you that it shouldn’t.

Although implementing Revenue Guardian is not an exact science due to the reliance on organization-specific intricacies, there is a right way to evaluate scope and approach design so that your organizations’ revenue integrity team can experience a similar level of success that other Epic organizations have.

For example, at the Ohio State University Wexner Medical Center, they used revenue guardian to prevent $10 million in denials and increase gross revenue by an estimated $2.5 to $5 million.

Your organization can do this too, but you first need to understand the possible failure points of a Revenue Guardian implementation, and how to mitigate those risks.

Here are the top three failure points of a Revenue Guardian implementation:

  1. Overambition with Revenue Guardian checks – This is arguably the most common issue organizations experience. It’s understandable that revenue integrity teams would get a little overzealous when they realize the possibilities of revenue guardian, but it’s important to take a phased approach to implementing Revenue Guardian, starting small and growing as your team becomes more comfortable with this new functionality.
  1. Lack of defined processes and procedures – Another common pitfall of a Revenue Guardian implementation is that organizations will typically put the cart before the horse. They define the checks, but not the processes needed to work these checks. Defining the processes and procedures, however, is just as important, and if this step isn’t taken, your team won’t have the tools necessary to actually work these Revenue Guardian checks.
  1. Insufficient resources – Last but not least, there are some organizations that lack a structure within their revenue integrity team, and do not currently have the manpower to take on the work effort required to handle Revenue Guardian checks. This doesn’t necessarily mean you need to add FTEs, but it does mean you need to be cognizant about restructuring priorities and responsibilities within your team and potentially within the back-end of the revenue cycle. Implementing Revenue Guardian should not create a net-increase in work, which is why a thoughtful and deliberate approach to resource allocation is necessary for success.

This may seem daunting, especially if you are brand new to Epic, but again, it shouldn’t be because we can help. Our team at The Wilshire Group has spent countless hours working with organizations to ensure their Revenue Guardian implementation is successful.

Through historical claims and denials analysis in addition to focus group discussions with leaders at your organization, we will help you create a targeted list of Revenue Guardian checks. Next, we will establish a phased approach to implementation and work with your revenue integrity team to produce the processes and procedures necessary to work these new edits. Last but not least, we will analyze your current resource allocation and embed the updated responsibilities and priorities into the aforementioned processes and procedures to ensure your team is ready for Revenue Guardian.

So what do you say, is your revenue integrity team ready take the plunge into the Revenue Guardian world?