HealthCare Financial

Financial Billing Information System Interface

The original EMR/HER to Financial ERP AR-GL implementation plan (before my time) was to perform an ETL process (Extraction, Transform, and Load) from the EMR/EHR Billing summary-level file directly into the Financial ERP AR as a ‘Ready-To-Post’ batch. Thus keeping the customer detail level in the EMR/EHR system and the summary level in the Financial ERP. The thought process being that the data sets coming from the PPC EMR/EHR application were:

  • Complete transactions; Associated records rolled-up by GL Acct, by Date
  • Balanced batches (Credits = Debits)
  • Correct GL Account Number associations
  • Correct AR posting dates

What Finance discovered was that none of the above was valid. Hence, needed and warranted was a new approach to process financial data accurately.

Assigned to this task, I initially went thru the data sets available from the EMR/EHR application and detail required for the AR-GL batches. Thereafter, I sat with the Controller to ascertain what the Accounting department fully expected from this interface. During these sessions, I proposed the possibility of all PPC financial transactions going through a single gateway, a single source of input into the Financial ERP. The concept took hold and adopted.

The challenge: a three (3) month imposed deadline.

  • Developing a single source (of truth) interface capable of ETL for:
    • Two (2) Clinical Billing systems
    • One (1) Revenue Cycle Management system
  • Creating a stand-alone, yet fully integrated AR Subsystem
  • AR, GL & BI time-based performance data reporting dashboards
  • Interface into Hyperion for budgeting

Below is the high-level solution design. From there, the design was broken into sizable, workable pieces and assigned. The most tedious parts of the solution were:

  • Creating / pulling the LOD (Level of Detail) from the EMH/EHR and Revenue Cycle Management solutions
  • Creating a soft-coded UI/API-based GL Mapping Tool and a ‘Validation Rules’ based interface such that validation rules could be changed at a moment’s notice without developer interaction
    • Accounting simply entered or deleted parameters into the GL Mapping Tool and/or the ‘Rules’ engine
    • These parameters applied automatically to the next batch of incoming transactions
  • Developing the LOD of the BI analysis needed/.required by the PCCs

Financial Billing Information System Interface
Financial Billing Information System Interface

Financial Billing Information System Interface Tie-out
Financial Billing Information System Interface Tie-out

The actual project took six (6) months from initial development to production-ready use. This is not to say all aspects were complete; rather that the internal processes proved-out and the interface put into production use while additional dashboard development continued.

The development required one (1) full-time .Net developer, one (1) full-time and one (1) part-time SQL developers, and three (3) full-time BI developers with the support of three (3) accountants and one (1) auditor.