By Charlie Bauer, Senior Director, Delivery Operations

Single Billing Office (SBO) is a mode in Epic offering the highest level of integration available in Epic’s billing suite. It blends the self-pay functionality and workflows of both Resolute Hospital Billing and Resolute Professional Billing into a consolidated billing system. About 50% of Epic clients use SBO mode.  

Earlier this month we outlined the top benefits of moving to Epic Single Billing Office (SBO), but now we want to discuss some of the operational impacts and considerations that should not be taken lightly when thinking about going SBO. 

1. Which end-users will need training?

Take a moment and think like a PB Customer Service rep. You have literally never had to think about what a “revenue code” is in 20 years of working at your organization. Then one day, your boss comes in and tells you that everything you know today is only half of what you need to know a few months from now. You are scared, you’ve never had to think about a “revenue code” or a “DRG,” and you are probably angry too because you are a high performer today. Will you be a high performer tomorrow?  

As the theme suggests, converting to SBO is not just a technical switch – for some staff, it is a full-scale re-education effort. Epic workflows will change substantially for some billing office staff. Professional Billing staff that once used PB Tools will need to be trained on the HB toolset to accommodate SBO workflows. These include Enterprise Payment Posting, HB Account Workqueues, HB correspondence and letter functionality, and hospital account payment plans.

Additionally, staff that answer calls will need to be trained and versed in both applications to offer a seamless customer service experience. They will need to perform research in both applications on charges, payments, and adjustments. They will also need to understand insurance adjudication in both applications – this in and of itself is a tremendous undertaking. 

These are just some of the training questions you need to consider. Tegria has a dedicated Training Solutions team ready to come help you create, manage, and execute a plan to get your staff up to speed before they answer that first integrated phone call. We’ll even help you hire the Credentialed Trainers and build the curriculum if you need it.  

2. Who will be your visionary SBO executive?

Perhaps the single most important decision you will make before transitioning to a Single Billing Office model is who the top-level executive leader will be. This transition is about so much more than financial success, it is about cultural success, and choosing someone who will message to the front-line staff living in all of this chaos that things are going to be okay, that they are in the safe hands of someone who knows what they are doing, is decisive, and will not let them fail. 

It is critical to make this decision as early in the process as possible to allow this person to be the ultimate decision-maker and advocate for major decisions, organizational chart restructuring, and policy consolidation. Bringing someone in after all decisions have been made can lead to a situation where the leader wants to go back and re-make decisions, re-validate workflows, and is generally not a cheerleader or accountable for the outcome of the go-live. 

The SBO executive leader should report to the same person as the leader of your Hospital and Professional Business Offices. They need a measure of independence from both the HB and PB leaders. This person needs to be a thoughtful decision-maker with strong change management skills, the ability to integrate separate teams, and is capable of building a unified culture. 

If you don’t know who this person will be, it might not be the right time for you to transition to SBO.   

3. Will there be layoffs?

Any large organizational change causes anxiety, and Single Billing Office is no exception. People are worried about anything being implemented for the sake of efficiency, especially in lower-paying front-line jobs because they traditionally are the easiest to cut. These folks are worried about losing their livelihoods and what that would mean for themselves and their families. 

Determine future state organizational charts and staffing early on and keeping your teams informed along the way with regular, transparent communication. This will lessen a lot of unnecessary anxiety and control the flow of information to remove the power of rumors. 

One approach we have seen be successful is appointing a communication lead. Once decisions are made, a combination of memos, team meetings, and town halls have helped organizations stay ahead of the rumor mill. If you are uncertain of the right messaging for your consolidation, Tegria will help you create and deliver organized communication and change management plans for clients’ improvement initiatives.   

4. How will the self-pay follow-up, customer service, and cash posting teams be consolidated? 

One of the bigger operational impacts of converting to Epic SBO is the consolidation of each of the self-pay follow-up, customer service, and cash posting teams, from two to one. You have team members on both the HB and PB side who are, in many cases, deeply loyal to their supervisors and managers. If you don’t make and communicate clear decisions you could end up with a team unsure of who they should be reporting to, and learning from – the old manager, or the new one? 

Merging these teams allows for many efficiencies as you simplify the management structure. But how will this be done? What will the new organizational charts look like in your Single Billing Office?  

For example, there is currently one HB and one PB self-pay follow-up manager. There is only a need for one in the future. Will one be laid off? Become a supervisor? A ‘special projects’ manager?  

As efficiencies within staffing are identified, how will decisions be made? Productivity can be measured across the department before and after conversion so teams are consolidated with the best staff moving forward. 

5. Where will the SBO teams sit and when will the transition occur?

Staff for hospital and professional self-pay follow-up, customer service, and cash posting are typically located in separate locations before the transition to SBO. Because the teams will most likely have consolidated management, the staff should be in a centralized location to experience the true benefits of a unified team. Will the new, larger team fit in the existing hospital business office? Will new office space need to be acquired? Will the physical move happen before the conversion or go-live? 

Determining this as soon as possible, and identifying new space if necessary, will lessen other would-be problems as the conversion nears. Tegria’s experience with SBO and centralized Patient Access Centers means we can help you create everything from seating charts to floor plans to all the facility and office space decisions in between. 

6. How will your discount policies be consolidated?

Prior to converting to SBO, hospitals and physician groups typically have extremely different discount policies. This includes self-pay, employee, and charity discounts. All these policies will need to be consolidated as patients and employees will expect the same treatment when receiving a combined statement for both balances. You will need to review both the hospital and physician policies and come to unified terms for the patient population moving forward.  

Tegria can help you by facilitating these conversations as an independent mediator and provide your SBO executive leader with recommendations based on the experiences from our network of clients. This specific decision emphasizes the need to identify your executive leader to have an ultimate final decision-maker because otherwise decisions swirl and progress is blocked.  

7. How will patient payment plan terms be consolidated? 

In addition to the self-pay discount, other policies and procedures will need to be consolidated such as payment plan terms. Will you use the hospital’s existing payment plan terms? If so, do your physician groups agree with that approach? What will need to be compromised?  

This can also be complicated if you are currently using vendors for payment plans. Some organizations even have separate physician group and hospital payment plan vendors. Getting both sides of the house to reconcile their terms—and to decide whether to use a vendor or build in Epic—is a major decision in and of itself, especially if you don’t have much centralized control within your physician group. Generally, Tegria recommends using Epic’s native payment plan functionality, which is highly configurable. We can help you navigate these tricky decisions. 

8. What customer service line will be used? 

One of the biggest benefits of moving to SBO is the ability to consolidate customer service teams. This change will typically require moving to a single customer service phone line to streamline your patient experience. This new phone line will appear everywhere from your new single statement, to your website, even your Google Business listing! 

In the long-term this will be a positive transition, but it will require working with your telecommunications team to minimize confusion for patients.  Don’t forget – if you’re using an Interactive Voice Response (IVR) system to help patients find the right customer service rep or make payments, it’s very likely that the setup will need to be reviewed. 

As we discussed, combining customer service teams means making decisions related to cross-training, and your IVR will need to reflect that decision around whether or not to cross-train HB and PB customer service staff to direct patients to the correct team. Additionally, organizations often use the transition to SBO to create tiered career paths within customer service, and your IVR will need to be updated accordingly. 

Tegria can help you sequence your decisions to avoid the chaos that can come from all these interdependencies and make sense of all of the confusion. 

9. What bad debt and collection agencies will be used?

Both your hospital and physician groups likely have existing relationships with their own set of bad debt and collection agencies. How do the collection terms compare? Would existing vendors be able to handle additional inventory? Does your hospital side work their own Bad Debt, while the medical group sends it to an agency? What will you do in the future? 

Implementing an SBO is the perfect time to review these existing vendor relationships and explore if it’s time to rework your contracts and update terms. Tegria can you help you not only evaluate your vendor decision but also conduct a vendor performance evaluation to help you determine who to go with in the future. 

Deciding on a bad debt vendor can feel like the easy part compared to nailing down the future state workflows and making sure they are reflected accurately in Epic. Tegria can help your operations folks understand exactly what they are being asked to validate and to ensure the correct automation setup. 

10. How will self-pay payments be distributed? 

With this new platform, you’ll want to review your self-pay posting hierarchy to determine whether patient payments should post to the oldest outstanding balance first, whether to give preference to professional or hospital balances, determine where undistributed payments should go, and decide if leftover funds should apply to a patient’s bad debt balance.   

Any one of these changes could make a financial impact, too. And the most contentious point is often whether to distribute to PB or HB first – since everybody wants cash for themselves! So, be sure to include your finance teams in the decision-making conversations. 

Still have questions? Contact us.