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EPIC Questions

  1. Default EPIC Questions
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    Our hospital will be using EPIC early next year. Can anyone tell me how this system has changed for better/worse in their job as a medical coder? Any advice would be most appreciated! I am trying to do some research on the pros/cons and what to expect when training starts.

    Greatly appreciate your time!

    Tammy, CPC

  2. #2
    We are going to Epic in October of 2019. I don't have much to offer right now but I have heard it streamlines your coding processes off of work lists and I am told our coders will work a lot of the billing edits but I guess that will depend on your facility. If EPIC has a listserv you may find getting access to that would be beneficial because you will be able to ask the EPIC community questions as you have them in preparation of go live.

    Kind Regards,
    Stephanie Moore, CPC, CPMA
    AAPC Chapter Association Board of Directors 2016-2019
    Region 1 - CT, MA, ME, NH, NY, RI and VT

  3. #3
    Greater Pittsburgh Pennsylvania Chapter
    In my opinion EPIC is only as good as the package they purchase. With that being said coders still have to look at the codes being selected and check documentation just like we had to do previously. From a coding standpoint the only thing that I really dislike is that you will see a lot more incorrect diagnosis codes selected since the docs go in an just start clicking and picking without having a full understanding of the ICD-10 coding guidelines. Once you get all the kinks worked out and get a good system going you will see that like anything else there are good points and bad.
    Michelle Ray-CPC,CSFAC

  4. #4
    Default Epic EHR
    Hello - I am an Epic instructional designer/trainer for professional and hospital coding at the Hospital for Special Surgery in NY. I've been an Epic trainer for over 12 years. I just wanted to give my thoughts.

    Clinical - providers will document in Epiccare and select appropriate E/M and procedures from a populated charge list that is created for them prior to go live. They also have the ability to add other charges not listed on their list. They will also select and link the Dx codes. When the provider signs the encounter, charges are released and are reviewed by charge edits in the charge router (high level checks - think charges with fatal errors such as charges not in system, no guarantor account, etc). Those errors are typically worked by your analysts. If no charge router edits charges are then checked against charge review workqueue edits (CCI/LCD and whatever edits your organization creates - you can create your own rules). Depending on your organization set up, coders will work these charge review workqueues for coding. In smaller organizations, the office manager will work the coding charge edits.

    If the charges have no errors, they just keep swimming down the revenue cycle stream. When you first go live on Epic, your org may have set up a 100% charge review, where you will check documentation and charges for ALL encounters to ensure it accuracy. This allows you to educate providers initially, but also get you tooling around in the chart to get more familiar with it. After about 90 days, the 100% review is reduced to about 2% or your compliance department may set up a workflow where they push certain accounts to your charge review workqueues for review.

    The charges are then checked for claim errors defined by your organization. Claim edits route to claim edit workqueues that are worked by billing staff, registration staff and coders, depending on the edit. Edits here can be coverage related (which will be a LOT at go live), billing related and coding (I find these coding claim edits to be repeats of charge edits because end users can bypass charge edits if they have security to do so).

    Once the claims are clean, they are released to a third party clearinghouse that checks for additional edits. If the clearinghouse finds errors, they will send the claim back to Epic for someone to fix (not necessarily coding errors). If there are no errors, the claims go to the payors.

    When a denial is received, the biller will note the account and set a flag that coding needs to be reviewed (if it's a coding denial, that is, they also do this for registration and billing denials) and the account routes to an account workqueue for coders to work. The coder will review the error, update any Px, Dx, etc, note the account and then remove the coding review flag so the account routes back to the biller. The biller will then rebill or perform other actions based on your findings.

    That's about it in a nutshell. It's the same workflow for IP and OP Hospital coding as well, except there is a button that launches the encoder. In 12 years, the encoder has always been 3M. You enter info into 3M and then that info is pulled into Epic. Some organizations may have you launch 3M outside of Epic (the Encoder button won't open 3M). The coder would have manually enter info into 3M and then manually enter 3M findings into Epic because the link isn't there. That's currently how it is at HSS, which is being changed to the launching 3M via the Encoder button.

    It's a pretty slick system. The one complaint I get from coders is that information in the chart isn't as robust as it needs to be - it is, but it wasn't accounted for to be included on coding reports. But this is quickly fixed!! You would just tell your analyst what chart information you want to see and they add it to your coding report. It's just frustrating at first having to dig and dig to find stuff at go live.

    Hope that helps a little bit. Again, this is just my experience with coding/charging in Epic. The above are typical foundation Epic workflows for coding. One thing I would recommend is that you ask for what you want.

    Good luck!!
    Kelley O

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