St. Luke's University Health Network Transforms Revenue Management During System-Wide EHR Implementation

"I don't think you could paint a better picture than what happened during the Epic transition"


In the summer of 2014, Bethlehem, Pa.-based St. Luke's University Health Network (SLUHN) was operating on a pair of disparate electronic health record (EHR) systems across each of its six hospitals in Pennsylvania and New Jersey. In an effort to enhance operational and revenue cycle efficiencies and better connect care across the continuum, SLUHN decided to move forward with system-wide implementation of the Epic EHR.


SLUHN executives were well aware of the scale of this investment and its inherent risks. A number of essential decisions had to be made, including whether to take a “big bang” approach of going live with Epic at its hospitals simultaneously or phasing-in the implementation gradually. This decision was complicated by an ongoing ICD-10 transition.

“A phrase that rang true throughout the Epic implementation was, ‘You don’t know what you don’t know,’” said Richard Madison, vice president of revenue cycle services at SLUHN. “One thing we did know was that we needed an experienced partner to assist us through all facets of this process.”

SLUHN engaged Guidehouse McKinnis to assess its organizational structure and provide insights on Epic implementation strategies and best practices.

“We did our homework, connecting with other Epic hospitals to better understand success metrics,” Madison said. “The Guidehouse McKinnis name came up often, both in the context of partnering with providers pre- and post-implementation, and in instances where initial installations didn’t go as planned and they were brought in to address issues. That really clicked with our chief operating officer and helped to finalize our decision.”

Guidehouse McKinnis collaborated with SLUHN’s IT and billing analysts to provide implementation support, operational direction, and general insights on how to maximize Epic revenue cycle functionality. This included partnering with system leadership to develop strategic goals based on such key performance areas as:

  • Billing timeliness and claims acceptance - Getting bills out faster and cleaner through a more hands-on approach to identifying areas of concern and enhancing the unbilled, known as candidate for billing (CFB), organizational strategy.
  • Baseline cash collections - According to Epic best practices, providers should expect to return to a cash neutrality baseline within 48 weeks of implementation. Through its assessment of and assistance with CFB, claims and charge testing, and revenue reconciliation, Guidehouse McKinnis provided metrics and data to help speed up the process of getting cash back to baseline.
  • Denial management - Redefining workflows related to denial management processes and point of services collections, and making them more intuitive and easier to follow.

An area of particular focus was the charge capture process, especially as a growing number of clinical department managers questioned why some charges were being credited or how they were being recognized. In one instance, a department was using additional procedure codes that were already considered included in the primary procedure, which led to confusion, crediting, and lost revenue.

With the strong support of SLUHN leadership, Guidehouse McKinnis conducted a series of workshops prior to conversion to educate clinicians about tools available to help them better manage charge monitoring. The sessions focused on the need for greater discipline around the reconciliation process, including getting clinical sign off on future charge codes and having clinical managers accept ownership for reconciling charges on a daily basis. In addition, Guidehouse McKinnis met with facility finance directors on a daily basis to stress the significance of revenue integrity while instructing directors to review revenue daily and identify what might be driving under- or overcharging.

Once the processes were established, department managers across facilities began to charge more accurately, helping SLUHN to realize an immediate lift in revenue.


The engagement had a significant and rapid impact, including:

This was a monumental, system-wide change management process, and our team responded extremely well to it. I don't think you could paint a better picture than what happened at our health system during the Epic transition, and our Guidehouse McKinnis partnership played a major role in this success.

Richard Madison, Vice President of Revenue Cycle Services, SLUHN

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