The Revenue Cycle Relay Race

This report is your primary safety net. It lists patient encounters that have been clinically closed (e.g., patient discharged, visit ended) but are still "open" from a billing perspective because no charges have been entered. It's designed to catch potentially missed revenue at the earliest possible stage.

Pain Point:

This indicates a significant process delay (charge lag) in a department's workflow.

Diagnosis:

• Filter the report by department. Are the delays concentrated in one or two specific areas?
• Look at the provider column. Is a single provider or a group of providers the source of the backlog?
• Analyze the encounter types. Is the issue specific to certain procedures or visit types (e.g., consults, new patient visits)?

Action/Solution:

• Engage the Department Leader: Present the data. Ask them to walk you through their team's current charge capture process.
• Identify the Bottleneck: Is it the provider not signing their notes? Is it administrative staff not having dedicated time for charge entry? Is there confusion about who is responsible?
• Collaborate on a Fix: This could involve provider re-education, adjusting staff duties, or creating a daily checklist for the department to ensure all encounters are reviewed for charges within your organization's goal (e.g., 48-72 hours).

Pain Point:

This points to a technical issue or a misunderstanding of the process. The charges they "entered" are likely stuck and haven't posted to the account.

Diagnosis:

• Take one specific patient example from the report.
• Go to the next step in the process: the Charge Router Reconciliation Detail report. Search for that patient's encounter.
• You will likely find the charges sitting in a Charge Router error queue. Note the error reason.

Action/Solution:

• Show, Don't Just Tell: Go back to the department leader with the specific error from the Charge Router. Explain that "entering" charges isn't the final step; they must be "accepted" by the system.
• Resolve the Root Cause: The error might be something the department can fix (e.g., missing diagnosis pointer) or something that requires an IT ticket (e.g., invalid charge code). Address the underlying issue.
• Educate: Teach them how to check their own department-level charge review workqueues so they can proactively identify and fix these errors themselves.

This report is a more targeted version of the Open Encounters report. It specifically flags encounters where a provider has completed and signed a clinical note, which is a definitive trigger that a billable service occurred. It helps pinpoint process breakdowns that happen *after* the clinical work is documented.

Pain Point:

This reveals a workflow disconnect and lack of ownership in academic or team-based care settings.

Diagnosis:

• Is this trend isolated to specific teaching services or clinics?
• Review the provider column. Are the same attending physicians consistently appearing?
• This is less of a data issue and more of an operational one. The data is simply highlighting the process failure.

Action/Solution:

• Clarify Responsibility: Meet with the Service Line Chief or Medical Director. The process needs to be black and white: Who is ultimately responsible for ensuring charges are entered after the attending signs the note? The resident? The attending? An administrative partner?
• Systematize the Handoff: Implement a clear handoff. This could be a specific Epic In Basket pool, a shared note template, or a daily huddle checklist.
• Hold the Right Person Accountable: Once the process is defined, use this report to hold the responsible party accountable for clearing their items.

This report shows the real-time status of charges. You should focus on:

• Transferred: Success! The charge made it through the router and is on its way to posting.
• Error: Critical stop. The charge is stuck in a workqueue and will NOT become revenue until it's fixed. This is your highest priority.
• Warning: A "soft" stop. The charge may post, but it has a potential issue that could lead to a denial later. These need to be reviewed.
• Deleted: The charge was removed. This requires investigation to ensure it was appropriate.

Pain Point:

This is a major bottleneck. It indicates either a systemic technical problem or a widespread knowledge gap in the department.

Diagnosis:

• Group the errors by their description. Is it one single error message appearing on hundreds of charges? (e.g., "Missing ordering provider," "Invalid place of service").
• If it's one repeating error, it's likely a technical or charge build issue.
• If there are many different types of errors, it's more likely a staff training issue.

Action/Solution:

• For a Single, Repeating Error: This is a high-impact fix. Partner with your Epic IT analyst. A single fix to the charge master (CDM) or a system rule could release all of those charges at once. This is a huge win.
• For Multiple, Varied Errors: This requires a training approach. Pull a few examples of each error type. Create a simple "job aid" or tip sheet for the department. Schedule a 30-minute training session with the staff who enter charges to review the common errors and how to prevent or fix them.

This report is best used for trend analysis and validation.

• Compare Period over Period: Run the report for this month and last month for a specific department. Did their posted revenue drop significantly? If so, this is your starting point for an investigation using the other three reports.
• Validate New Services: If a department started a new procedure or service line, use this report to confirm that the new charges are actually posting to accounts. If you see zero volume, you know there's a problem upstream.
• Look for Zeroes: Run the report for a department and look for expected CPT codes with zero volume. For example, if you know a clinic gives injections, but you see no administration charges posted, that's a red flag for missed revenue.

Pain Point:

Department leaders are busy. You need to present them with irrefutable evidence of a gap, not just a hunch.

Diagnosis (The Full Reconciliation Story):

1. Start at the Finish Line: Show the leader the low volume on the HB Posted Charges Summary. "Here is what we successfully billed for Procedure X last month."
2. Work Backwards to the Start: Pull the scheduling or clinical documentation data. "I can see from your schedule that you performed 50 of these procedures."
3. Show the Gap: Use the Revenue Guardian reports. "Of those 50, these 15 encounters never had any charges entered at all."
4. Identify the Blockage: Use the Charge Router Detail report. "And of the 35 that were entered, these 10 are stuck in an error queue and haven't become revenue."

Action/Solution:

By connecting all four reports, you've built an airtight case. You've quantified the total opportunity (25 missed/stuck charges) and pinpointed the exact points of failure. The conversation shifts from "I think there's a problem" to "We have an opportunity to capture revenue from these 25 procedures. Let's work together on a plan to fix the process for the 15 missed encounters and resolve the technical errors for the other 10."