Impact Insights

Epic Workqueues and Revenue Cycle

Leigh Burson

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.

 

23 thoughts on “Epic Workqueues and Revenue Cycle

  1. Avatar Michelle says:

    I work at Saint Lukes and we have Epic. I am in Radiology scheduling and our workque is so high not sure how it should be worked there is 1500 in deferred and about 600 in the queue. How should this be maintained.

    1. Leigh Burson Leigh Burson says:

      Michelle, Thank you for your question. It’s hard to tell in your question exactly which type of workqueue you are referencing. I would imagine, given your role, that it is either a scheduling or patient workqueue. These workqueues are worklists and have current and future state contacts in them and will probably always be full. Deferred is normally used as a tickler where you have called a patient and are waiting for them to respond, need additional information, etc. I would be happy to talk to you and understand a bit more if you want to reach out to me at leigh.burson@impact-advisors.com.

      Thank you!

  2. Avatar Zara says:

    Hello, Do you know how to filter a hospital workqueue by the first letter of a patient’s last name? We have 4000 accounts in the workqueue and we want our staff to only focus on their assigned alphas. Any help would be greatly appreciated. Thank you.

    1. Leigh Burson Leigh Burson says:

      Zara,

      Thanks for the question and sorry for the delayed response. If you want to divide records among workqueues using an alpha split to more evenly distribute work among staff members, you need to add the range of letters to your workqueue rules. There is a great Epic Galaxy article located here: https://galaxy.epic.com/?#Browse/page=1!68!50!1241259,1241300,2482295
      that should help you. Good Luck! -Leigh

  3. Con you give me some ideas of how to divide a collection workqueue among 3 reps to be able to equally be assigned to collect from the same workqueue. Each rep has a goal of prepayments to collect and we will be working off the same workqueue . I currently am doing this myself and two other reps will be joining my team and i want us to be successful with out conflict on who is getting more accounts . are there settings or do we just haft to go with the flow .

    1. Leigh Burson Leigh Burson says:

      Thank you for your email. It depends on what version you are on, etc. In the past, account workqueues used Collection (KCR) rules instead of the Rule Editor (CER) rules that are used in other PB workqueues. With CER rules I believe you would be able to create some rules and filters to help get you closer to what you are looking for in dividing work. If it all prepayment you would be using Credit WQ’s and there is feature called Record scores where the system applies scores to records based on criteria that you define. Users sort their workqueues by score so they can work records with the highest scores first, etc and that may be a good option. I would recommend working with you Epic TS on the best options since they know your system and workflows. Thanks and Good Luck! -Leigh

  4. Avatar ali wickham says:

    is EPIC capable of highlighting an account in red within the workqueue. like if a due date is approaching

    1. Leigh Burson Leigh Burson says:

      Ali,

      Thank you for your question. There are many different types of WQ’s in Epic so depending on the type it depends. There is some functionality where you can send an In-Basket message to a user when ticklers are due if it is determined a good use by your organization but it requires some set-up. The Active and Deferred tabs in WQ’s are for that purpose as well so the individuals can set up their own ticklers for follow-up. I would recommend working with you Epic TS for your application and talking through your use cases and options. Thanks! -Leigh

  5. Avatar M. says:

    How can I view all the accounts I’ve worked from the workqueue in a day?

    1. Leigh Burson Leigh Burson says:

      It depends on your security and exactly what you are wanting to view, but there are Account Workqueue Productivity logs that can be run from a reporting perspective. The audit trail captures all the activities on an account so if there is not a report already available, it should be something that can be produced. I would reach out to your manager or director and see how they are pulling the information. Good Luck!

  6. Avatar Kelja says:

    Good Morning,

    Is it possible for physician surgical claims to be on a 10 day delayed billing cycle to ensure the hospital claims are submitted first to exhaust the patient’s deductible amount. If so what would be the process

    1. Leigh Burson Leigh Burson says:

      Kelja, I believe you are referring to PB? I would suggest using charge router or charge review WQs for the pre AR. If you let a claim generate and had late charge you would have to reprocess the claim. HB has MIN days to allow charges to enter before the claim generates.

  7. Avatar Belle says:

    When the coverage order is updated in epic, is there a way for the payments to follow the charges even when the value change from one carrier to another? For example: We have a patient with BCBS and UHC, we have received payments from both carriers. however,the coverage order needs to be change from UHC to BCBS (instead to BCBS to UHC). can the payments follow the new charges even though the value changed.

    1. Leigh Burson Leigh Burson says:

      Belle,
      Thank you for your question. I would recommend working with your Epic TS on these items. This is a bit outside of the workqueue discussion and coverage filing order can be customized within the configuration table, so someone would need to understand the set-up and the reasons it is working that way today. Good Luck!

  8. Avatar Belle says:

    it is possible to update coverage dates in epic without having to retro.

    1. Leigh Burson Leigh Burson says:

      Belle,
      Another good question, but I would refer you to your Epic TS here as well. Visit Filing Order (VFO) has come a long way and how you determine dates for retroadjudication, etc. in set-up differs by organization. Previously, the system wouldn’t review non-primary coverage changes for retroadjudication, but non-primary visits can now be considered for review. There is a great strategy document for visit filing order on the Epic Userweb that I would recommend. Good Luck!

  9. Avatar Mark says:

    We have one main WQ which is divided into smaller WQ’s for easier manageability. The smaller WQ show account is completed. However it has not fallen off. Some accounts 3 months old. Why have they not come off? Do they need to be transferred back to main WQ.

    1. Leigh Burson Leigh Burson says:

      Mark,
      Thank you for the question. It sounds like you have a rule that needs to be adjusted on your WQ. I would test each one of the rules in your WQ and determine which one is failing. They should not have to be transferred back to the Parent WQ. The rules are all captured under the parent. If you are uncertain on how to test there is some good information on the UserWeb.The properties can be tricky so a simple tweak might resolve it quickly. Good Luck! -Leigh

  10. Avatar DeMelva says:

    I have a question… What does the ” WQ Scoring” Column represent? I see this within my follow up WQ’s in Epic.

    Thank you in advance for your help

  11. My staff works insurance credit WQ’s- since they are transaction driven verses claim driven we find it hard to set an hourly standard. For example if claim has five lines and I clear 1 credit – it appears I worked 5 transactions- when in fact I touched 1 patient account. So I can clear 100 transactions in just a few minutes when another staff member might be investigating primary coverage and send letter request for recoupment.

  12. Avatar Janice Mantanona says:

    Does EPIC have the functionality of using the side bar (chart) when working on “Follow up” WQ’s (denials)?
    Currently, I know that you can review the chart on the side bar when working in charge review.

  13. Avatar Christy says:

    Is there a way to do a small credit or small balance write off under $5?

  14. Avatar Paulette says:

    Hello. Is there a way to hold all claims on a MRN for a set period of time to prevent claims that are to be included in a bundled bill packet from being billed separately?

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