One of the most common questions I hear is:
“Why don’t you just turn on all the Revenue Guardians?” 

It’s a fair question, especially from teams using Epic’s Foundation System. On paper, flipping all the switches sounds efficient. In practice, however, the devil is in the details. 

As a revenue integrity professional and consultant, I’ve never advised a client to “just turn them all on.” That machete approach often backfires—hard. I’ve seen organizations do just that, only to turn them all off again after being overwhelmed by noise, false positives, and operational chaos. The trauma from that experience can be lasting, often stalling further progress for years. 

Instead, at Wilshire, we take a thread-the-needle approach, customized, measured, and focused on aligning operations, IT, compliance, and revenue cycle teams. We believe in making improvements while the ship is still sailing, building stronger sails and engines without halting progress. 

Start Small, Think Strategically 

Revenue Guardian edits can be immensely valuable—but only if deployed with intention. 

For example, many organizations struggle with missing implant or device charges—particularly in procedural areas like the Cath Lab. In those scenarios, we focus first on Revenue Guardian checks related to device-dependent procedures. The build must be comprehensive, but equally important is the operational plan for resolving any edits that fire. 

If a Revenue Guardian flags a missing pacemaker, who’s responsible for resolution? Revenue Integrity? Clinical teams? Our recommendation is that Revenue Integrity owns the edits—at least initially. This centralizes oversight, ensures accurate root cause analysis, and often uncovers systemic issues, like inconsistent chargemaster data or misaligned HB/PB workflows. 

False Positives Reveal Hidden Problems 

Let’s say a Cath Lab pacemaker procedure triggers a missing implant edit. The clinical team insists the pacemaker was used—and they’re right. The problem isn’t a missing charge; it’s the wrong Revenue Code—0278 instead of 0275. 

A clinical operator isn’t going to spot that nuance. But your Revenue Integrity team will—and that’s exactly the kind of insight Revenue Guardians can surface if implemented correctly. 

It’s Not Just Technology—It’s Strategy 

Epic’s Foundation Revenue Guardian build is a menu, not a turnkey solution. Success depends on what you choose to implement and how. Before activating edits, you must assess: 

• The Chargemaster for accuracy and alignment with operational workflows 

• Key commercial payer contracts, especially for device-heavy services 

• HB/PB reconciliation and shared logic for how charges route and are reviewed 

Yes, HB and PB can be cross-fertilized. Yes, your Revenue Guardians can be tailored. No, flipping all of them on at once is not the answer. 

 

Operational Alignment Is the Engine 

This brings to mind another common challenge: outpatient coding workflows. In many implementations, there was never clear alignment between HIM and revenue integrity. Teams were left unsure whether codes should come from the HIM coders or be hardcoded in the charge master. The result? Inconsistencies, overcoding, undercoding—and often a reactive decision to “give it all back to HIM.” 

These reactions are understandable. When the ship is sinking, no one is talking about how to rebuild it—they’re just trying to stay afloat. But once stability returns, too few organizations go back and redesign workflows the way they should be. That’s not just disappointing—it’s expensive. 

Fixing the Hole in the Boat 

Many say, “If it ain’t broke, don’t fix it.”
I say, “It’s only half built. Finish building the boat.” 

You don’t need a full-scale implementation to make meaningful changes. Start small. For instance, just look at Cath Lab workflows. Build procedure charges in Cupid. Configure implants and supply charges to flow from the system. Route procedure CPTs to HB and PB simultaneously—or clone from one to the other. Send implant charges to HB only. Let HIM review the charges in a workqueue the next day to preserve oversight while keeping revenue moving. 

This gets revenue booked timely, maintains coding accuracy, and reduces rework. 

Then layer in Revenue Guardian checks: start with procedure/device dependency edits in high-dollar areas. Tailor them based on your actual workflows, charge master data, and payer requirements. And remember—this can scale across multiple hospitals, driving enterprise-wide efficiency, compliance, and reimbursement gains. 

 

At Wilshire, we believe in building smart, building strategically, and keeping operations moving forward while we optimize behind the scenes. You don’t need to flip every switch, just the right ones. 

Let’s thread the needle, not swing the machete.