October 16, 2019

Professional Billing Insurance Follow-Up(date)


In the August 2019 version release, Epic introduced a major update to the way insurance follow-up is worked in professional billing.

For those of you not familiar with Epic release notes or the intricacies of professional billing, this is big (Harry marrying a commoner big). This is the single most significant update to the Epic professional billing system since the creation of Professional Inquiry (the combination of Transaction, Visit, and Invoice Inquiry) in the 2014 release. Below I will highlight what the update entails, why it matters, and what your organization should do about it.

Not all Epic applications were created equal. Some were created by Judy in a basement in 1979 (i.e. Professional Billing) while others had the luxury of an intergalactic headquarter with modern technology (i.e. Hospital Billing). Due to this discrepancy, as well as the subtle differences between HB and PB, similar functions in the two systems are not always accomplished in the same way. This has always been the case with insurance follow-up, until recently. The Epic professional billing developers took a page out of the hospital billing companion to simplify and streamline the way PB staff follow-up on denied claims.

While the release note has lots of helpful information and details all aspects of the upgrade, I assume most people do not long onto the User Web for their nightly reading. With that in mind, here are the four things you need to know about the upgrade and why they matter:

  1. Staff can now preform ALLinsurance follow-up actions in a single activity.
    • Impact: Increase number of denials worked daily
  1. Epic can be configured to link actions in a streamlined workflow
    • Impact: Increase payments due to the effectiveness of insurance follow-up
  1. Insurance follow-up reporting will produce greater insight into denials and staff productivity
    • Impact: Decrease denials by adding understanding to successfully resolved denials
  1. Professional Billing and Hospital billing become one workflow closer to standardization
    • Future Impact: Reduce CBO staffing requirements

Sounds great, doesn’t it? But now what? First, find out when the August 2019 upgrade will be installed at your organization. Next, do a deep dive of denials and insurance follow-up workflows to understand how to best re-design the professional billing system. Finally, do the build. But it does not end there.

To get the most out of Epic and your staff, it is critical to set up policies, procedures and operational oversight to ensure your organization can pivot in conjunction with today’s rapidly changing reimbursement regulations. If you want additional information on what the update entails, what your organization should do about it, or how The Wilshire Group can be of assistance, do not hesitate to reach out to Tyre Pierce at t.pierce@thewilshiregroup.net, I would love to talk.


Senior Strategic Advisor

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