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Eight Ways to Get the Most Let the Disputes Begin!

Out of Your EHR System Implementation of No Surprises

Are you struggling with your EHR system? Act Hits High Gear

You’re not alone. The American Medical Association and associations at
all levels of organized medicine have been actively
involved in addressing the implementation of the Federal
EHR systems present healthcare organizations with the No Surprises Act which provides surprise billing protec-
opportunity to improve workflows, enhance the patient tions for patients and has the potential for significant net-
experience and generate better clinical outcomes. work disruption. One of the most hotly debated compo-
Unfortunately, EHR systems aren’t always optimized, nents of the Act was the Independent Dispute Resolution
which can cause more work and greater headaches for (IDR) process given the potential for the administration of
both your clinicians and patients. the process to have a significant impact on contractual
If you’re looking to get the most value out of your sys- negotiations and network development at the local level.
tem, below are eight steps to ensure you’re taking full Failure to implement the IDR process fairly will have
advantage of all the benefits your EHR system has to offer. major ramifications on care delivery.
1. Foster a partnership with IT. On August 19th, the Departments of Health and
To get the most value out of your EHR system, IT and Human Services (HHS), Labor, and the Treasury (the BY RAFAEL J.
Operations need to be working in tandem. An Informatics FERNANDEZ, JR., MD
BY ALEXANDER leader can act as a crucial bridge between the two depart- Departments) released the first update on the volume of
BINELO ments to ensure everyone is speaking the same language. disputes that have been filed since the launch of the IDR.
For the four-month period from April to August, over 46,000 disputes were filed
2. Create an EHR Leadership Advisory Council. which according to the Departments were “substantially more than the Departments
This council should be prepared to advise on matters of initially estimated would be submitted for a full year.”
quality of care, cost of care, clinician adoption of technology and future enhance- While the volume of disputes is attention catching, the hidden headline is that the
ments from the EHR. certified IDR entities rendered a payment determination in more than 1,200 disputes
3. Check your benchmarks. during this four-month period. For physicians concerned about how the No Surprises
If you’re in a particularly competitive market, you should be benchmarking yourself Act will change insurance company behavior in terms of contracting and potential
against your peers to identify opportunities for improvement in areas like patient sat- reductions in out-of-network payment, the trends and details of these 1,200 decisions
isfaction and readmittance rates. Then, explore how your EHR system can support are critically important, although not yet available as far as I am aware.
your plans to address these gaps. There are several resources available for physicians to follow the implementation of
4. Redesign your workflows. the IDR process. The Departments have launched a comprehensive webpage entitled
Your workflows should be tailored to maximize the value of your EHR system. “Common mistakes and helpful tips for parties initiating an IDR dispute” which
Identify if there’s any misalignment between your existing workflows and your EHR includes a link to the portal where disputes can be filed. The AMA has also created a
system and make adjustments accordingly. toolkit to guide physicians on the implementation of the No Surprises Act.
5. Bring your system up to date. The DCMA will continue to update our physician members as more details emerge
Check with your vendor to see if you’re behind on any system updates. If so, on dispute resolution trends and determinations from the certified entities.
upgrade your software as soon as possible so you can take advantage of new capabil-
ities and optimization opportunities. Dr. Rafael J. Fernandez, Jr., is President, Dade County Medical Association.
6. Revisit your communication plan.
Your EHR system shouldn’t be static — it should be constantly evolving, which
means you need a proactive, flexible and consistent communication plan to keep
everyone in the loop.

satisfaction

7. Train your workers. o Y our pa t ients’
Use role-based training to help users learn how the EHR system fits into their

responsibilities.
. .
8. Put your data to work. isn’t a number
If your EHR system is properly implemented and optimized, you should be gather-
s
ing high-quality data, which can be used to generate predictive insights related to It’ s an
KPIs like no-show risk and days-in-hospital. To get the right insights, make sure

you’re consistently measuring what you want to impact. experience .

Alexander Binelo, Partner, The BDO Center for Healthcare Excellence & Innovation, can
be reached at abinelo@bdo.com or (786) 477-5418.

Contact:
Alfredo Cepero, Managing Partner
(305) 420-8006 / acepero@bdo.com

Angelo Pirozzi, Partner
(646) 520-2870 / apirozzi@bdo.com

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