How to Switch EHR Systems Without Disrupting Billing

Most practices make the mistake of measuring the cost of an EHR they want to migrate to instead of focusing on the migration itself. What really impacts your practice is the denial reports that appear after going live.MGMA discovered that EHR changes result in authorization and other billing issues that increase claim denial rates. This is because migrating EHR systems requires a documented path with each step defined and considered thoroughly. It’s a long overdue process that damages the revenue if poorly managed and results in disrupting billing. To make sure that everything stays in control and smooth, you need to make sure that your transition process is not a mess.

The Billing Risks That Might Occur While Switching EHR Systems

Before we start the EHR systems switching process, you should know the billing risks that can occur during this period. The real issue is that the EHR vendor focuses on implementation and your IT team focuses on when to go-live. Neither of them considers billing consistency which creates disruption.

As you know, each claim is generated through a dependency chain; EHR to charge capture to claim generation to clearinghouse then payer. Switching EHR means every link in this chain is at risk simultaneously. It’s not that every new EHR implementation puts this chain at risk but the chances are there. The real problem is that the system appears to be working fine until you see the denials.

The most common breaking points during switching EHR systems are:

• Mismatches in registration and demographics.
• CPT and ICD-10 mapping
• EDI and ERA connections aren’t reestablished
• Not reconfigured NCCI edits and payer rules
• Staff’s unfamiliarity with the new system

How to Protect Your Billing When You Switch EHR Systems

With all the risks considered, here’s a step-by-step EHR switching guide that won’t put your billing at risk:

Step 1: Run a Billing Configuration Audit Before Data Migration

By billing configuration means before migration even a single record, it’s better to document everything that the new system will need to replicate. This is basically a validation checklist you make that you sign off before going live with the new EHR.

What the audit must cover:

• List of the fee schedules by payer
• Every active ICD-10 and CPT code set that you currently use
• Payer-specific modifier requirements and claim editing rules
• Currently configured NCCI edits in the system
• All authorization records tied to active patient cases
• List of active clearinghouse connections and EDI/ERA mappings

This is a must have list for keeping billing consistent throughout the adaptation of the new EHR system. If your practice skips this step, expect denials after a few weeks of going live.

Step 2: Assign or Outsource Billing Continuity

If you have a billing department at your practice, that’s great. If you have outsourced billing to a company that’s even better. But the issue arises if you don’t have a team to continue billing in the implementation stage. Make sure that you have a few experts at your disposal for this task which include:

• RCM Director: an individual who owns the overall billing continuity plan
• Lead Coder: who validates ICD-10/CPT mapping and charge capture configuration
• Billing Manager: who oversees clearinghouse setup and payer enrollment
• Clearinghouse Contact: expert who confirms EDI/ERA connections status before go-live.

The only mandate these individuals have is to protect the claim integrity from the initial audit through the first months post go-live.

Step 3: Audit Your Existing Data Before Migration

Patient demographics, insurance IDs, active authorization records, and coordination of benefits shouldn’t be considered just clinical data. These are the foundation of your billing and will contribute to processing clean claims after the transition.

If there are any existing errors in data, it can result in rejected claims or halt your billing cycle. So it’s suggested that you audit your data, its integrity and use this simple rule; flag, fix, then migrate, not the other way around.

Here’s what a data audit must include:

• Active authorization that need carrying forward
• Duplicate or incomplete patient demographic records
• Insurance IDs that are not verified or expired
• Any open claims in progress
• COB records for patients with multiple payers

Step 4: Notify Payers and Confirm Clearinghouse Connections Beforehand

This is the step that most practices treat as an afterthought and becomes a major issue at launch.

You don’t have to re-enroll with payers but it does require proactive notification when you switch EHR. Payers need to know you are changing the system to update information on their end. More importantly, clearinghouse EDI submission and ERA receipt connections must be reconfigured. 

Here’s what you need to do:

• Notify all active payers
• Reconfigure EDI claim submission
• Reconfigure ERA receipt
• Test end-to-end claim flow
• Confirm payer-specific claim formats

Step 5: Run a Parallel Billing Cycle

Parallel billing cycle means keeping both, your existing and the new EHR active for two to four weeks after you go-live. Your old system will be used to cross-check the new system’s claim output. If the same encounter results in a different claim in the new system, there’s misconfiguration.

A dual-system yielding will give you cross-check billing accuracy and resolve outstanding claims as well. Because if you catch a configuration gap in this window (parallel billing), it will cost nothing more than time. But if the same thing happens after this period, there will be denials which will cost rework, staff time and delayed reimbursements.

Step 6: Train Your Billing Staff Before Going Live

Some EHR vendors onboard your practice and give generic walkthroughs of system features during their sessions. These sessions don’t prepare your billing team with real claim scenarios with no role-specificity and workflow based instructions. This is why it’s best to ask for a proper training session from the vendor or through an expert in the new EHR. 

Ask your vendor for a role-by-role training for:

• Front desk / registration staff: This will include patient data entry standards, eligibility check process, and insurance verification workflows.
• Medical coders: This training will include the charge capture configuration, CPT and ICD-10 code mapping, and modifier rules specific to your payer mix
• Billing staff: Such sessions will teach claim submission workflows, denial queue management and ERA posting process.

Moreover, ask for an on-going training support post launch. Because the learning curve isn’t instant and lack of training will lead to coding errors, delays in resolving denials and claim submission mistakes.

Monitor Billing Performance for the First Quarter

If you are not planning to go with post launch support for the first quarter, it’s better to monitor everything closely to find issues and resolve them at their earliest yourself. The basic vendor packages include support for a few weeks after go-live and this is the time when your billing is most exposed.

Here’s what to track weekly through the first quarter post go-live:

• First-pass resolution rate: This metric measures how many claims are paid without rework
• Clean claim rate: If it drops below your pre-transition baseline, you need to act fast
• AR days: Watch out for any increase in the A/R days as this is a result of claim submission problems

What to Do When Denials Happen After the Launch

Even if you do everything right, there are still chances of denials in the first few weeks. What matters is how quickly you can tackle this challenge and close this gap.

If denials occur post-transition, do these steps:

• Trace denial reason back to its origin
• Cross-reference against the legacy system
• Prioritize high-dollar denials first
• Document every misconfiguration
• Keep the legacy system accessible

When to Outsource EHR Systems Migration

Some practices are better when going into an EHR switch with a partner who has done it before. This isn’t because the internal team isn’t capable, but an experienced partner takes care of all the audits, checklists, migration, and support.

Also, if you want an RCM partner to take care of the billing alongside, we bring such specific value during EHR transition as well. We provide integrated billing and RCM support that protects the claim integrity from day one. If your practice is planning a transition, we would love to have a conversation about how we can be of help.