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EPM and EHR Charge

Interactions

Presented by:

The Implementation and Training

Department

Agenda

• Understanding Encounter Types and Options

• Understanding Table Relationships between EPM and EHR:

Charges and ProceduresDiagnosis and Problems

• Overview of Options Available for Charges from EHR to EPM:Holding Tank

Real Time

• Submitting Charges from EHR to EPM – Holding Tank

• Submitting Charges from EHR to EPM – Real Time

• Breaking the Link between EHR and EPM Charges

• Considerations for Using Holding Tank vs. Real-Time

• Workflow and Process Protocols for Changes made in EPM to Chart in EHR

Encounter Types

Encounters created in EPM default to Billable

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Encounter Types

Encounters created in EHR default to Clinical

Encounter Types

Encounters created in Optik default to Billable and Optical

Encounter Types

Encounter Types seen in each NEXTGEN® application:

EPM

Billable

EHR OPTIK

ClinicalOptional:

Billable

Optical

Optical

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Encounter Types

Practice Preferences > Encounters Tab > “When Creating a New

Encounter Set Types to: Billable / Optical / Clinical”

Leaving all options unchecked lets the system drive the encounter

type based on the application in which it was created.

Encounter Types

When implementing EHR, two options are available to ensure

encounters created in EPM are also available in EHR:

1. On the first day of EHR go-live, select the Clinical option in Practice

Preferences. New encounters created in EPM will now default to

Billable and Clinical.

NOTE: This option will not show billable

encounters in EHR that were created in

EPM prior to EHR go-live.

Encounter Types

2. Have all EHR users select the Billable Encounters option in

their User Preferences.

NOTE: This option will show all billable

encounters in EHR that were created in EPM

prior to EHR go-live.

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Encounter Options

Practice Preferences > Encounters Tab >

“When Copying from Last Encounter, Copy Encounter Details /

Diagnosis / Insurance”

Selected options apply to creating new encounters in EPM and EHR.

Table Relationships

EPM Charges table and EHR Procedures table:

EPM EHR

Charges Table

• SIM Codes

• Modifiers

Procedures Table

• SIM Codes

• Modifiers

NOTE: Charge modifications made in EPM will update the Procedures Module in EHR but not the E&M Coding template.

Table Relationships

EPM Diagnosis table and EHR Problems table:

EPM EHR

Diagnosis Table

• Dx Codes

Problems Module

• Dx Codes

NOTE: Diagnosis modifications made in EPM will update the Procedures Module in EHR but not the Assessment or the Problems Module in EHR.

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Table Relationships

EHR Problems

EPM Diagnosis

Charges from EHR to EPM

Two options are available for sending and processing charges

from EHR to EPM:

1. Holding Tank

2. Real-Time

Charges from EHR to EPM – Holding Tank

Option 1 – Holding Tank:

EPM EHR

“Holding Tank”

Pending

Charges

Charges Procedures

Reports: EHR Manual Charge Processing – History

EHR Manual Charge Processing – Pending

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Charges from EHR to EPM – Holding Tank

Holding Tank:

Enterprise Preferences > General Tab > “EHR Manual Charge

Processing” = checked

This enables the holding tank between EHR and EPM.

Charges from Interface to EPM – Holding Tank

Holding Tank:

EPM

“Holding Tank”

Pending

Charges

Charges Charges

Interface Setting:• All Charges

or• Errors Only

INTERFACED SYSTEM

Reports: External Manual Charge Processing – History

External Manual Charge Processing – Pending

Charges from Interface to EPM – Holding Tank

Holding Tank:

Enterprise Preferences > General Tab > “External Manual Charge

Processing” = checked

This enables the holding tank between an interfaced system and EPM.

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Submit Charges from EHR to EPM – Holding Tank

Flow: E&M Coding Template to Procedures Module

Submit Charges from EHR to EPM – Holding Tank

Flow: Office Services or Nurse Visits Submit to Superbill

Submit Charges from EHR to EPM – Holding Tank

Flow: Superbill to Procedures Module

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Submit Charges from EHR to EPM – Holding Tank

Flow: Procedures Module to Holding Tank

Process EHR Charges in EPM – Holding Tank

Flow: Holding Tank to EPM Charge Posting

Individual Encounter – User is prompted to Accept or

Reject the charges from EHR

Process EHR Charges in EPM – Holding Tank

Flow: Holding Tank to EPM Pending Charges Process

File > Processes > Pending Charges

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Process EHR Charges in EPM – Holding Tank

Flow: Holding Tank to EPM Pending Charges Process

Multiple Encounters – User Accepts or Rejects the

charges from EHR

Process EHR Charges in EPM – Holding Tank

Flow: Holding Tank to EPM Reports

Reports > General >

“EHR Manual Charge Processing – History”

“EHR Manual Charge Processing – Pending”

Process EHR Charges in EPM – Holding Tank

Flow: Holding Tank to EPM Reports

“EHR Manual Charge Processing – Pending” Report

“EHR Manual Charge Processing – History” Report

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Charges from EHR to EPM – Real Time

EPM EHR

Charges

• SIM Codes

• Dx Codes

• Modifiers

Procedures

• SIM Codes

• Dx Codes

• Modifiers

Option 2 – Real-Time:

• Charges are received real-time into EPM as soon as

they are submitted from EHR

• “EHR Manual Charge Processing” reports are not

available in EPM

Charges from EHR to EPM – Real Time

Real-Time:

Enterprise Preferences > General Tab > “EHR Manual Charge

Processing” = unchecked

This disables the holding tank between EHR and EPM.

Processing EHR Charges in EPM – Real Time

Flow: EHR to EPM Charge Posting

Procedures Module to Charges Table – No Holding tank

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Processing EHR Charges in EPM – Real Time

Flow: EHR to EPM Charge Posting

Individual Encounter – No prompt – Charge has been

sent through and is ready for billing

Processing EHR Charges in EPM – Real Time

Flow: EHR to EPM Charge Posting

EPM Pending Charges Process

“No records found” – holding tank disabled

Processing EHR Charges in EPM – Real Time

Flow: EHR to EPM - Reports

No “Holding Tank” reports

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Breaking the Link: Rejecting Charges from Holding Tank

EPM EHR

“Holding Tank”

Pending Charges

Rejected in EPM

Charges Procedures

Pending EHR charges that are rejected in EPM cannot be retrieved. They must

be manually re-entered in EPM

Breaking the Link

Breaking the Link

Breaking the Link: EHR Locked encounter

• If the encounter is locked in EHR, new charges added and/or

modifications made to existing charges on the encounter in EPM

will not flow back to the encounter in EHR.

EPM EHR

Charges EncounterX

Breaking the Link

Breaking the Link: SIM Library

• The “link” between EHR and EPM can be broken for specific SIM

Codes in the Service Item Library.

Suppress Patient Procedure:

Prevents an EPM charge from

crossing to EHR Procedures

Module

Suppress Billing:

Prevents an EHR charge from

crossing to EPM for billing

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Considerations: Holding Tank vs. Real-Time

1. Enterprise Setting

• The Holding Tank setting is turned on or off in Enterprise

Preferences

• Therefore, the setting applies to all practices (single or

multiple) within the same enterprise

Considerations: Holding Tank vs. Real-Time

2. Copays in EPM

Holding Tank:

• When processing pending EHR charges in EPM, the user is

prompted to utilize the unapplied credit (co-pay) collected at

check-in on the EHR charges. (NOTE: User must have an active

transaction batch.)

Real-Time:

• A transaction batch is automatically created in EPM and

unapplied credits (co-pays) collected at check-in are

automatically applied to EHR charges. (NOTE: The batch is

named “Auto Apply Unapp Enc Credit Batch”)

Considerations: Holding Tank vs. Real-Time

3. Coding Review and Audit before Billing

Holding Tank:

• Charges from EHR cannot be billed until they are

“Accepted” in EPM

• Billing staff in EPM have the ability to review and

modify CPT4 and ICD9 codes before billing

Real-Time:

• Charges from EHR are saved in EPM as soon as they

are submitted

• Charges could be billed before Billing staff in EPM

has reviewed (timing is critical)

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Considerations: Holding Tank vs. Real-Time

4. End of Day – Auto-Close or Manual Close

Holding Tank:

• Charges from EHR cannot be processed (closed)

until they are “Accepted” and saved in EPM

Real-Time:

• Charges from EHR are saved in EPM as soon as they

are submitted – can be processed (closed) that day

Workflow and Process Protocols

Develop Processes for End of Day Balancing/Reconciling of Charges

• Continue to use paper fee tickets for a period of time to compare

against charges in EPM.

• Review “Super Bill” in EHR against charges in EPM for services

submitted by nursing/clinical staff (e.g. in-house tests, injections etc.).

• Review “Kept Appointments with No Charges” report in EPM to identify

missing charges.

• Review “EHR Manual Charge Processing - Pending” report in EPM for

charges from EHR that are still pending.

• Review “Appointment Listing” report in EPM to compare total kept

appointments to total numbers of E&M codes submitted/accepted.

• Review “Daily Charges” report in EPM for all charges to be billed.

Workflow and Process Protocols

Develop Processes for Coding Changes and EHR Charting

• Electronic process should mimic current paper process.

Example: Currently, what changes made on the paper fee

ticket are also made in the paper chart for documentation?

• Changes made in EPM for billing that do not need to be reflected

in EHR. Example: Additional Dx code added for billing to

increase reimbursement.

• Tasks: Notify provider of change for reference only.

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Workflow and Process Protocols

Develop Processes for Coding Changes and EHR Charting

• Changes made in EPM for billing (e.g. incorrect Dx code) that need

to be reflected in EHR.

• Tasks: Notify provider of change.

• Provider updates EHR chart using an addendum on a locked

encounter. Documents changes/details, signs the

addendum and generates an addendum document.

• Provider resolves the incorrect Dx code adds the correct Dx

code to the Problems Module for future encounters.

• Provider updates their favorites to remove the incorrect code

and adds the correct code for future use.

(NOTE: Charge modifications in EPM will update the Procedures Module in EHR but not the E&M

Coding template. Diagnosis modifications made in EPM will update the Procedure Module in EHR but

not the Assessment or Problems Module.)

Workflow and Process Protocols

Develop Processes for Coding Changes and EHR Charting

• Each practice/clinic must have process and protocols defined and

in place prior to go-live.

• State and federal guidelines could dictate specific workflows and

protocols.

Demo.

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Questions?

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