Smarter Billing by Design
Integrating a custom inter-hospital billing system into an Epic launch.
The Challenge
A large academic medical center was in the process of implementing a new ADT and billing system to replace its decades-old legacy system. As the results of this Epic implementation, the partner hospitals were being moved into three new separate service areas. Our client needed an innovative solution for automatically capturing the inter-hospital charges among all partners. These captures involve Lab and Pathology services that are provided by one facility and charged on a patient’s account at the purchasing facility. The existing process was labor-intensive, provided no real traceable or reportable functionality, and relied on after-the-fact remediation, which often resulted in delayed reimbursements to both entities involved. Based on our previous work together, our client engaged LaPlant to lead its internal IT group and Epic vendor in the design and development of automated solutions for inter-hospital billing.
LaPlant Solution
We knew from experience that Lab and Pathology had diverse and complex needs to be addressed in this technical solution. We understood the diverse requirements for successful inter-hospital billing, along with the capabilities of the Epic system being implemented. Working closely with the client, we paid special attention to ensuring that the needs of all affected departments were met—including Lab Medicine, Pathology, Charge Master Operations, Accounting, Finance and Leadership. We paid ongoing attention to clearly communicating the requirements from the operational decision makers to the IT developers.
Based on these requirements, we worked closely with the vendor and our client’s IT team to develop custom programming rules using Epic’s Charge Router. The outcome was an automated solution that: systematically identifies when one facility is providing inter-hospital services to another facility; routes charges from the performing facility to the patient’s account from the purchasing facility; and routes a copy (clone) of charges from the performing facility to a separate account for settlement with the purchasing facility.
We also helped create complex testing scenarios, which demonstrated that the solution performed as required in even the most demanding situations. In addition to ensuring the system’s success, these testing scenarios helped increase stakeholder confidence prior to launch.
The Results
Our client’s new automated charge-capture process has delivered immediate and long-term results across multiple departments, from the front end—Lab and Pathology—to Billing and Accounting. The new programming has eliminated additional conversion steps related to pricing in our client’s separate service areas. It has also reduced delays in reimbursement, inter-hospital late charges, corrected claims, and the costly need to bill twice for the same service.