Epic Work queues and Revenue Cycle

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Mar 08, 2017

Epic Work queues and Revenue Cycle

Written by Impact Advisors

Category: Revenue Cycle

Workqueues are a cornerstone of Revenue Cycle management in Epic; they can provide powerful functionality to keep business operations running smoothly. However, it is not uncommon for organizations with Epic’s Foundation system to struggle at go-live and thereafter, when team members do not know how to properly and efficiently utilize workqueues.

At no fault of their own, Application Teams work in silos on their build in trying to meet “build bucket deadlines” and, as a result, an opportunity to build based on your organizational workflows is lost. Building anything properly the first time always makes life easier, and building workqueues in Epic is no different. It is much more difficult to correct and clean-up workqueue build once Epic is live than it is to take the initial effort to carefully design, build and test your workflows right at the start.

Here are a few things to keep in mind as you start your build or look at optimizing workqueues:

Workqueues should mimic your workflows – Take your workflows and map out a life of an account across your workqueues. This will ensure the flow from workqueue to workqueue is intuitive and that stakeholders have a workflow to follow.

Use claims from your legacy system to reproduce accounts. Use a mix of very common (diagnostic imaging, etc.) and complex workflows (workers comp, case management, etc.). Ensure that every workflow is accounted for in your build.

Let’s take an example of a patient who comes in with an order for an imaging procedure. In this situation, you might implement the following workqueues:

  • Schedule Order WQ- Capture the order for scheduling the test and then schedule it
  • Patient WQ – Drive the future encounter to a pre-registration workqueue or capture any missed information for a current encounter
  • Patient and Account WQ – After pre-registration you might have someone review the patient’s benefit information, create an estimate for a patient and determine a pre-payment
  • Account, Claim Edits WQ – Coding and Billing would need to review any coding edits or claim edits that were triggered prior to the claim dropping
  • Credit, Adjustment Review and Follow-up WQ – Once the claim is processed, billing may need to follow-up on credits, adjustments, or denials

Ensure that the criteria for why accounts hit a workqueue and why they fall off is clear and well understood – This must be well-defined for testing and support. Trainers can use this information as they develop training criteria.

Test your build– A reminder to test might sound unnecessary, but when rolling out a new build, testing is crucial. Make sure that you include negative results testing as well as positive results testing and ensure that your back-end and front-end edits are in-sync. Any revisions you have on claim edit or account workqueues should also be captured on pre-registration and registration workqueues since they are worked and owned by different sets of users. For example, if a claim requires a referring provider, and that piece of information is captured at registration, it should be reflected in both your patient workqueues as well as your claim edit workqueues.

Assign an owner to every workqueue – Accountability is key. IT will own system issues and Operations will own workflow issues.

Emphasize workqueue training – Workqueue training is often offered at a very high level during an organization’s initial training, but is always revisited at Go-Live. Workqueues are the way you support and run Revenue Cycle in Epic and it is critical that the users understand the expectations of what is hitting a workqueue, why and how they correct the issues. Create a plan for end users outlining the different types of workqueues and how to work the errors.

When built well, Epic workqueues can be powerful. Taking the time to ensure that you have each piece of your workflow (scheduling, registration, insurance verification, charging, claims, etc.) accounted for will ensure that you have a streamlined process for your end users to follow.

Click here for more information on Impact Advisors’ revenue cycle optimization services and additional thought leadership.