10 Tips for Managing Your Hospital Billing Watch List

During Epic implementations, system assessments and optimization projects, we frequently find the Epic watch list section of the hospital billing overview dashboard is missing accounts, creating an Epic “black hole.”  

This happens when clients set up their Epic system and stop certain accounts from appearing in the workqueue and on the work list, which leads to account neglect and lost revenue.   

When optimized, the watch list can be a valuable tool for revenue cycle managers. Is your hospital billing watch list neglected?  

Here are 10 tips to optimize your Epic watch list: 

1. Review and fine-tune your watch list criteria shortly after your initial Epic go-live.

First, make sure accounts route to workqueues appropriately. Next, add filter rules to prevent false positives from showing up inflating numbers on the watch list. For example, the “Outstanding Ins Not on WQ” check will identify accounts that are not on a workqueue 30 days after a claim was sent. But, if you have certain accounts with an intentionally longer follow-up period, like 45 days, then add a filter rule to prevent these account types from unnecessarily showing up on the watch list too soon. Also make sure you aren’t over filtering and inadvertently excluding accounts.

2. Check your “holding workqueues” to make sure you’re not hiding any problems or neglecting accounts.

If holding queues or filter rules exist solely to stop accounts from routing to the workqueue and showing up on the watch list, they may never be worked by an associate or a vendor – consider eliminating them to avoid this problem. One of our clients had hundreds of accounts in a holding queue that no one was working, which greatly impacted their revenue.

3. Build custom watch list alerts to supplement the standard watch list checks.

For example, add an alert to identify credit balance accounts not on a workqueue – always make sure this alert is actionable by the group using the watch list and there is a workflow in place so the team knows how to process them. We’ve seen many clients with custom alerts to identify accounts nearing timely filing or discharged not billed (DNBs) over a certain dollar threshold, but they never established a process to address the accounts that show up, which led to neglect. These account types can also be addressed via workqueue monitoring and workqueue prioritization.

4. Assign owners to each metric on the watch list to support accountability.

Additionally, review metrics’ trends weekly, but switch to daily reviews when there’s high volume. Ownership should also be documented outside of the system. We typically see our clients assign the billing team to maintain the metric ownership document.

5. Use the watch list to help identify broken or potentially missing workqueues.

The watch list should alert you to issues that are not getting addressed. Build your workqueues to automatically identify and route accounts to the “accounts should be discharged” or “accounts should be billed” sections so associates can proactively identify and correct issues before accounts become neglected. 

6. Reassess the watch list criteria after upgrades.

Occasionally upgrades and associated automatic changes can cause accounts to disqualify for workqueues and show up on the watch list. As Epic has increased the frequency of upgrades, it’s important for both operations and IT teams to work together to ensure that the system’s build, such as the work list criteria, continues to support revenue cycle operations. 

7. Make sure you’re using all sections in the radar dashboard needed to monitor your accounts receivable (AR) to identify potential “black holes.”

We often find clients over-customize their dashboards but fail to add the most updated dashboard sections for AR monitoring. We recommend using the standard Epic-released dashboards as much as possible. Epic has committed to maintaining these dashboards and adding new sections with every release.

8. Find infrequently worked and neglected workqueues.

For those infrequently worked, use the hospital billing workqueue monitoring dashboard. And for neglected workqueues, use the hospital billing workqueue monitoring reporting workbench report, which can be exported to Excel for further analysis.

9. Establish a governance process including your Epic IT and revenue cycle operations teams for system changes impacting your watch list and workqueue structure.

Our clients achieved a lot of success when they created an operations and IT governance partnership and produced SBARD (situation, background, assessment, recommendation, decision) documents to frame up the business requirements and rationale behind the build request. Additionally, they required signoff from key stakeholders and an oversight committee that helped ensure the requested change was truly necessary.

10. Create accountability and open communications for keeping your watch list clean involving both your Epic IT and revenue cycle operations teams.

For example, if operations submits a request to exclude certain accounts from specific workqueues, they need to indicate the workqueue those accounts should be routed to. Likewise, if IT makes changes to exclude accounts from workqueues, they should also make sure those accounts are routed to another workqueue and share that change with operations. We’ve found that establishing this infrastructure up front helps to prevent a “black hole” and account neglect. 

Is your hospital billing watch list neglected? Does your Epic instance need to be optimized to maximize revenue? We can help. We have more than 60 Epic experts with certifications across more than 130 Epic applications ready to help bridge the gap between your clinical, financial and revenue cycle teams. We leverage our experience across several different Epic instances to help take the guesswork out of redesigning and implementing new workflows that maximize your Epic investment.  

Contact an Epic-certified expert today to see how we can help.