Electronic Health Records (EHR) Systems for Medical Billers

Electronic Health Record (EHR) systems are the digital backbone of modern healthcare, and for medical billers, they are the command center for managing the revenue cycle. Understanding how to navigate these complex systems is crucial for success in the field. This guide will provide an in-depth look at two of the most popular EHR systems, Epic and Cerner, and explain how medical billers use them in their day-to-day work.

Whether you’re a new student or a seasoned professional, mastering these platforms is a significant step in your career. The U.S. Bureau of Labor Statistics projects a steady demand for medical records and health information specialists, making EHR proficiency a valuable skill. Bureau of Labor Statistics

The Role of EHRs in Medical Billing

At its core, an EHR is a digital version of a patient’s paper chart. But for medical billers, it’s much more than that. These systems integrate clinical and financial data, which helps to streamline the billing process from start to finish. An integrated EHR system can automate many of the tasks that were once done manually, leading to increased accuracy and efficiency. This means fewer errors, faster claim submissions, and quicker reimbursements for healthcare providers.

A typical day for a medical biller using an EHR system involves a variety of tasks, all managed within the software. This can include:

• Charge Capture: Reviewing patient encounters to ensure all billable services are accurately recorded. EHRs often have features that automatically capture charges based on the clinician’s documentation.
• Claim Creation and Submission: Generating electronic claims based on the captured charges and patient information. The system helps ensure claims are clean and compliant with payer rules before submission.
• Denial Management: Working through lists of denied claims, known as work queues, to identify the reason for the denial, make necessary corrections, and resubmit the claim.
• Payment Posting: Electronically posting payments from insurance companies and patients to the correct accounts.
• Reporting and Analytics: Running reports to track key performance indicators like claim denial rates, accounts receivable aging, and overall revenue cycle performance.

A Closer Look at Epic and Cerner

Epic and Cerner are two of the largest players in the EHR market. While they share many core functionalities, they have unique features and workflows that medical billers should be aware of.

Epic EMR

Epic is known for its comprehensive and highly integrated system. For medical billers, Epic’s revenue cycle management module, often referred to as Resolute, provides a robust set of tools. A key feature is the use of “work queues” that automatically flag accounts with issues that need attention, such as missing information or claim edits. This allows billers to focus their efforts on resolving problems that are holding up payment.

Cerner

Cerner’s revenue cycle management solutions are designed to streamline financial operations by connecting clinical and financial data. Medical billers using Cerner often work with its Patient Accounting system, which helps manage billing and collections. Cerner also provides customizable dashboards and reporting tools that allow billers to monitor the revenue cycle and identify trends.

The Pros and Cons for Medical Billers

While integrated EHR systems offer many advantages, it’s important to be realistic about their challenges.

Pros:

• Increased Efficiency: Automation of tasks like charge capture and claim submission speeds up the billing process.
• Improved Accuracy: Integrated systems reduce the likelihood of manual data entry errors, leading to cleaner claims.
• Better Communication: EHRs facilitate communication between clinical and billing staff, helping to resolve issues more quickly.
• Centralized Information: Having all patient information in one place makes it easier for billers to find the documentation they need to support a claim.

Cons:

• System Complexity: Both Epic and Cerner are large, complex systems that can have a steep learning curve.
• Workflow Rigidity: The standardized workflows in an EHR can sometimes be inflexible, making it difficult to handle unique billing scenarios.
• Cost of Training: Proper training is essential to use these systems effectively, which can be an investment for individuals and organizations.

The Impact on the Future of Medical Billing

The widespread adoption of EHRs has transformed the role of the medical biller. The focus has shifted from manual data entry to a more analytical role that involves problem-solving and process improvement. By leveraging the data and tools within EHR systems, medical billers can play a proactive role in improving the financial health of a healthcare organization. As technology continues to evolve, so will the skills required of medical billers. Staying current with EHR systems and other healthcare technology is key to a successful and rewarding career.