The areas that typically have the greatest reduction in labor are:
1. Billing / Claims Processing
2. Eligibility Verification
3. Filing
4. QA / Compliance Monitoring
The areas where you will need to assign staff or increase staff hours are:
5. User Help Desk
6. Training
7. Application Management
8. Report Development / Maintenance
9. Scanning
10. Database Administration
Let me help you with some details on each to consider when planning.
1. Billing / Claims Processing:
Most EHR Systems will require significantly less man/woman-hours to process and submit all your claims. You should be able to process them with just a few key strokes, selecting the site, program, or payor you want to process or the entire agency's claims. You can do this daily, weekly or monthly. You may want to do it weekly or monthly and have the biller move to another role on the non-billing days.
You will be creating a batch of pending services that the system will run through some error checking and payor rules. Your biller will be presented with a listing of the errors found and should have the ability to continue processing the claims without errors and hold the ones with errors aside for corrections. This usually only takes a few minutes. So, your billing staff will spend most of their time either escalating the errors to the clinical staff and/or fixing the ones that they have the ability to fix. E.g. Missing Dx or missing NPI #. They will no longer be reviewing each Progress Note and correcting/selecting codes. They will no longer be doing manual data entry into the IS.
For small and medium size agencies, I usually recommend you plan for one biller for the agency, and a back-up person to assist when they are out or error volume spikes. This person may not be needed for billing full-time and can be used in other areas on non-billing days. But, if you prefer to continue with a program or site based billing structure (decentralized), you will need one person for each billing area. This role, however, will likely not be a full-time role. You can have billers also handle the batch eligibility verification process, see below. Obviously it will depend on the error prevention capabilities of your system and the volume of claims you process.
In order to accurately estimate the staffing needed, you should: review the product billing workflow with your vendor, understand the typical errors you can expect and what your biller's responsibilities will be for corrections, estimate the volume of errors in each billing batch. Or ... talk to a reference account that is similar to your agency and see how many hours they spend billing!
2. Eligibility Verification
You should be planning to automate your eligibility verification with 270/271 EDI batch transactions. This will free up lots of time if you are currently processing these one by one each month for all your clients. If your vendor can support this, you can expect to have this done overnight each day for all clients and when your staff (or biller) comes in the next day, they can review the eligibility changes for each client. Some systems will require you to enter the changes into the client record, while others will process these automatically for you.
3. Filing - all gone! Especially if you enable electronic client signatures!
4. QA / Compliance Monitoring
This will be a whole new world for your QA/Compliance staff! Your QA staff should expect to print a report showing the client records that are not in compliance and can work directly from there. They no longer need to "hunt" for the issues, they will know exactly where they are. Now, of course this does not apply to qualitative clinical reviews. The system will not know if the Note is appropriate or not, but it will know if the Treatment Plan has been completed and signed or renewed on schedule! This alone will free up a significant amount of time across the agency, I'm sure. To plan for this area, again you need to understand the capabilities of your system to monitor and track the compliance rules; you also need to know how well the system can prevent a provider from moving forward in the client workflow without completing the previous step (some have lock-out capability for example).
5. User Help Desk
For most agencies, this will be a new role. You need, at a minimum, someone to triage each user issue reported. Some will be training issues, some IT issues, some will be EHR-S vendor issues, and some will be EHR-S configuration issues. I cannot highlight enough the importance of this role. You are moving to a workflow model that requires the PC, the network, the server, the Internet connection, and the database to be up and running all the time! You are also now dependent on the quality of your user training. Users need to be able to escalate an issue and get a quick solution.
6. Training
This will be a new role altogether. Your training leader needs to be a project manager, a training curriculum developer, and a trainer. They need to be very comfortable with computer applications and have the ability to pick-up your workflow and the EHR-S product quickly. I recommend you staff this in-house, but you may want to outsource the initial curriculum development and some assistance with the launch training.
7. Application Management
This is also a new role and a very important person. Let's call them the HIM (Health Information Manager) or EHR Coordinator, or something like that. This is your EHR-S "Champion". This person will lead all your agency's efforts after launch with the EHR-S. For example, interface to the vendor for contract compliance, enhancement requests, and version control; interface between the vendor, IT, training, management, and the users; leading the application change management efforts; can also develop reports and configure the system tables/screens, etc. This is also a project manager. I do not recommend this person report into the IT department, they should report into the operations management. They represent the users and management team foremost! This is the person I transition to at launch and the person I mentor and consult to during implementation.
8. Report Development / Maintenance
This is probably a new role for you as well. The EHR-S should have a report writer or you should purchase/license one. You need one leader here for report development, testing, and deployment. You also need a team of people who can modify reports and do other simpler tasks with report administration, maybe one per program or site. These can be part-time roles. For the more sophisticated EHR-S products, report development can be a very complex task and require database experience. You can always outsource the significant report development and absolutely should plan for assistance to get up and running for launch, but you should have these skills in house for simple report development and report change management.
9. Scanning
This is also a new role. You no longer need to file charts, but someone needs to scan in hardcopy documents and attach them to the appropriate client record or area within the record. This is a good centralized task, maybe for the current file clerk. It is unlikely this will be a full-time role. You need to review what hardcopy documents you will need to attach to the chart and develop a shredding policy for the originals. (re: Legal EHR)
10. Database Administration
This will be handled by your ASP, if you go that route (see my previous BLOG on this topic). If you self-host, then you can either outsource this task (ask your vendor is they will do it) to a database administrator, or hire someone with the appropriate database skills. This person may also be a good report administrator/developer, an application administrator, and possibly help with the Help Desk.
Hope that helps!
by Keely McGeehan, Sahara Management Solutions, Inc.
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