In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.

Lane JacksonWhether your organization is contemplating an electronic medical record (EMR) installation or is far along in completing one, you are in good company if you're concerned about a performance lapse in the revenue cycle. It's a common and worrisome byproduct of such an enormous undertaking.

It is a given that an EMR system is a valuable asset, and virtually all healthcare organizations have or will adopt an EMR for the technology's indisputable organizational and patient benefits. Although a lapse in collections efficiency—at least in the short term—may appear inevitable when installing an EMR, an organization can minimize the negative effects by adhering to leading best practices. Based on years of assisting clients and transforming revenue cycle operations, Grant Thornton partner Lane Jackson responds to the following FAQs with recommendations to maximize efficiencies in the revenue cycle before, during, and after go-live.

What are some best practices for an organization that is about to begin or is working through an EMR implementation?

There are several strategies that organizations should keep in mind:

  • Reduce revenue cycle backlogs. Before beginning an EMR implementation, you should clear the decks as much as possible in key areas. For example, you should reduce discharge-not-final-billed accounts to best-of-practice levels before a go-live.
  • Establish a transitional organizational structure. Within your business office, try to create a temporary structure for conducting billing and collections efforts. It's important to realize that day one work requirements between systems—both legacy and new ones—will differ greatly from requirements at day 90. As such, you should plan for this change by establishing a transitional organizational structure and making personnel aware of the approach.
  • Decide how you will utilize vendors and third parties. You will almost certainly need outside assistance to supplement your internal resources. Organizations should expect to reallocate resources for the EMR installation, and additional assistance is important to accomplish tasks that would otherwise be neglected. Before installation begins, you should evaluate how you will use vendors to minimize a drop-off in financial performance and determine the most effective time to begin or expand the use of vendors.
  • Prior to EMR go-live, repeatedly test the claims submission process. Test, test, and test again should be your motto. Testing should continue until you prove that bills will be generated and sent out to payers when you reach minimum hold days. The ability to submit clean claims in a timely fashion has the most substantial effect on revenue cycle performance.
  • Aggressively monitor key performance indicators. Immediately after go-live, begin monitoring key performance indicators, with charges as the primary focus. You should anticipate and validate that revenue is the same as it was in the previous system, and identify fluctuations and watch for red flags. If the charges are not entered, financial performance will suffer. Don't wait until the end of the first week or month to monitor—or to act.

What are leading practices for organizations that have completed their EMR installations but are still experiencing less-than-ideal performance?

In those cases, organizations should consider the following steps:

  • Revisit the organizational structure. You want to ensure that your resources and efforts are aligned properly, and that personnel work efficiently and effectively in both the legacy and the new EMR system.
  • Identify and resolve EMR build issues. Connect frequently with system users to learn about what is and is not working well. It is not realistic to try to fix everything at once; instead, prioritize optimization activities that drive the most value and have the most effect on revenue cycle performance.
  • Take advantage of vendors and third parties as needed. Backlogs and other issues can force internal resources to continuously deal with problem solving rather than moving forward with the new processes. At any point, you can engage outside assistance to allow your personnel to catch up with their work and settle into their new routine.
  • Refocus and re-energize. After what will be a vast amount of sometimes exhausting change, resources can lose their steam. It is critical to financial performance that staff and leadership return their attention to the day-to-day activities of running the revenue cycle.

Could you give an example of an organization that has been successful in maintaining or even improving revenue cycle performance during an EMR installation?

With diligent oversight, an organization's financial performance should produce better-than-historical results. This was the case for the State University of New York (SUNY) Upstate Medical University. Before implementing its EMR, the organization had experienced lagging cash collections and a rapidly aging accounts receivable.a Hospital staff teamed with Grant Thornton professionals to build and implement a best-of-practice revenue cycle to coincide with the EMR implementation. Results included optimized revenue cycle processes with cash baselines that recovered in less than half the average time; significant additional one-time cash generated prior to EMR and patient accounting system go-live; and considerable additional revenue on an annual recurring basis.

SUNY CFO Stuart M. Wright remarked on the outcome: "We needed a consultant that could quickly survey our organization and processes, develop a plan of attack, and help us execute. Grant Thornton did just that and more. In summary, today, most of our revenue cycle metrics are in the top quartiles of the country."

Where can a healthcare organization go to learn more about this topic?

For more information about how to optimize the revenue cycle during an EMR implementation, as well as how Grant Thornton can help, go to the website.


a. Jackson, Lane, and Oliver, Matt. Academic Hospitals Gains Best-of-Practice Revenue Cycle, Jan. 16, 2015.

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Publication Date: Wednesday, June 01, 2016