After an electronic health record (EHR) go-live, documentation and billing gaps can cost hospitals millions and leave patients with incorrect bills. Healthrise connects clinical care and the revenue cycle to protect both financial performance and the patient experience
Key Facts (At-a-Glance)
- The blind spot: Significant revenue loss can occur after an EHR go-live, when documentation and billing errors are most likely to happen and least likely to be detected.
- Extreme case: One large health system recovered close to $1 billion in revenue after Healthrise identified more than 400,000 patient encounters that were never closed following its EHR go-live.
- Root cause: In systems such as Epic, an encounter that is not closed never reaches coding and is never billed.
- The clinical-revenue connection: Healthrise aligns clinical documentation and the revenue cycle, so the care a provider delivers is the care the organization is paid for.
- Patient impact: Accurate documentation and coding protect patients from incorrect bills and reduce financial stress during recovery.
- Provider support: Personalized, one-on-one work with physicians eases the transition to a new EHR and improves adoption.
- The fix: Operational readiness, provider support and at-the-elbow expertise, built into the implementation from the start.
Why It Matters
- Hospitals operate on margins as thin as 1% to 2%, leaving little room to absorb lost revenue.
- More than 40% of providers report denial rates of 10% or higher, with incomplete documentation the leading cause.
- Two-thirds of providers believe AI can improve the claims process, but only 14% use it to reduce denials.
- Industry research documents a 15% to 25% productivity decline in the first three to six months after an EHR go-live.
- Reworking a denied claim costs hospitals an average of $118 per claim.
“Go-live is the midpoint, not the finish line,” said Jodie Hilliker, Senior Director of EHR Services at Healthrise. “Most of the financial risk in an implementation surfaces after the system goes live, in the daily work of the people using it.”
A $1 billion example of the EHR blind spot
Months after a large health system completed an EHR go-live, its finance team identified a major revenue shortfall it could not explain. Healthrise found that more than 400,000 patient encounters had never been closed, leaving the charts unbilled. After working with physicians to close them, the system recovered close to $1 billion in revenue and returned to stable financial footing within about two months. The example is extreme, but the underlying failure, encounters that are never closed, occurs at hospitals of every size.
What is an unclosed encounter and why does it cost money?
In platforms such as Epic, a provider must formally close, or sign off on, each patient encounter. Until the encounter is closed, the chart does not move to the coding department and the visit is never turned into a billable claim. A single open encounter has limited impact. Across thousands of encounters, the uncaptured revenue compounds quickly, often without appearing on standard financial reports until it reaches into the millions.
Connecting clinical care and the revenue cycle
Healthrise approaches revenue cycle and clinical performance as one system rather than two. A claim begins with clinical care: the order a physician enters, the authorization a provider secures, the documentation that supports the code. When those clinical actions are incomplete, the claim is denied and the organization loses revenue for care it has already delivered.
Healthrise was built to close that divide. Its teams work with physicians, coders and billing staff together and its specialists understand both clinical operations and EHR functionality, which lets them bridge the gap between technology and patient care.
Jodie Hilliker, who leads the firm’s clinical division, was brought on to work with revenue cycle leaders at Healthrise to bridge the gap.
Protecting the patient experience
For Healthrise, the goal of an EHR implementation is better patient outcomes. When documentation and coding are accurate, patients are billed correctly and spared an avoidable source of stress. Consider a patient who has just been diagnosed with a serious illness and then receives a bill for hundreds of thousands of dollars that is wrong, because the care was not documented or coded correctly.
Resolving it requires someone who can help the physician document the care correctly and help the coder code it correctly. Getting it right at the source means the patient can focus on recovery rather than disputing a bill.
Supporting providers through the change
A new EHR changes how clinicians work, which is a common source of frustration. Healthrise reduces it through provider personalization, working one-on-one with physicians to tailor workflows, templates, order sets and documentation tools to how each of them practices. This preparation builds confidence and improves adoption before go-live.
During go-live, Healthrise’s at-the-elbow specialists, many of them clinicians who have supported numerous implementations, stand beside providers and staff to answer questions and solve problems in the moment. Each engagement is designed to transfer knowledge and leave the organization stronger than it was before the project began.
Training versus operational readiness
Training teaches staff to operate the software. Operational readiness prepares them to perform their roles within it. Healthrise’s operational readiness team, led by Michele Woodley, guides nurses and registration staff through real patient scenarios before go-live. Relying instead on internal “super users” given only a day or two of additional training rarely provides adequate support during the demanding early days of a new system.
Why AI does not solve the problem
Adoption of artificial intelligence in healthcare finance is increasing, but it does not address the foundational workflow gaps that drive revenue loss. Healthrise advises hospitals to resolve those fundamentals first, then apply technology where it adds value.
“AI can draft a letter. It is not ready to repair a revenue cycle that was never built correctly,” Hilliker said. “The basics still determine whether an organization gets paid.”
How Healthrise helps hospitals prevent revenue leakage
- Conducts an on-site assessment before implementation planning to identify gaps in workflows, documentation and staffing.
- Builds operational readiness into the implementation budget from the start, including hands-on patient scenario practice for end users.
- Provides at-the-elbow support from experienced specialists who work alongside clinical and revenue cycle teams.
- Uses detailed analytics to track EHR adoption and return on investment after go-live.
- Identifies issues such as unclosed encounters before they accumulate, rather than after a shortfall appears.
For more information about Healthrise’s EHR services, operational readiness and go-live support, visit www.healthrise.com.
About Healthrise
Healthrise is a healthcare consulting and technology firm that helps hospitals and health systems strengthen both their financial and clinical performance. Founded in 2012, the company supports clinicians and end users before, during and after EHR implementation to help organizations reduce revenue leakage, improve satisfaction and protect the patient experience. Healthrise has supported more than 25 health systems and managed over $35 billion in net patient revenue. For more information, please visit www.healthrise.com.
Release Summary
- Hospitals can lose significant revenue after an EHR go-live, when documentation and billing errors are most likely and least likely to be detected.
- In one documented case, a large health system recovered close to $1 billion in revenue after more than 400,000 patient encounters were found to have never been closed following its EHR go-live.
- In systems such as Epic, an encounter that is not closed never reaches coding and never becomes a billable claim.
- Healthrise connects clinical documentation and the revenue cycle, so the care a provider delivers is the care the organization is reimbursed for.
- Accurate documentation and coding protect patients from incorrect bills and reduce financial stress during recovery.
- Healthrise reduces provider frustration with new EHRs through one-on-one personalization of workflows, templates and order sets.
- More than 40% of providers report denial rates of 10% or higher, with incomplete documentation the leading cause, per Experian Health’s 2025 State of Claims survey.
- Two-thirds of providers believe AI can improve claims processing, but only 14% use it to reduce denials, according to Experian Health.
- Artificial intelligence does not resolve the foundational EHR workflow gaps that cause most preventable revenue loss.
- Healthrise prevents revenue leakage through upfront assessment, clinical-revenue alignment, provider support, at-the-elbow expertise and post-go-live analytics.
FAQ
Yes. In one documented case, a large health system recovered close to $1 billion in revenue after more than 400,000 patient encounters were found to have never been closed following its EHR go-live. The figure is exceptional, but unclosed encounters cause revenue loss at hospitals of every size.
An unclosed encounter is a patient visit that a provider has not formally closed, or signed off on, in the EHR. Until it is closed, the chart does not move to coding and the visit is never billed, creating uncaptured revenue.
The period right after go-live is when staff are adapting to new workflows and documentation and billing errors are most likely. Because the loss accumulates gradually, it often goes undetected until it is substantial.
When documentation or coding is inaccurate, patients can receive incorrect bills, sometimes for large amounts and at a difficult time. Accurate clinical documentation and coding protect patients from that stress and let them focus on recovery.
Healthrise treats clinical and revenue cycle performance as one system. Its teams work with physicians, coders and billing staff together and its specialists understand both clinical operations and EHR functionality, so the care delivered is the care the organization is reimbursed for.
Healthrise personalizes the system for each provider, tailoring workflows, templates and order sets to how they practice and provides at-the-elbow support during go-live. This reduces frustration and improves adoption.
Training teaches staff how to use the software. Operational readiness prepares them for their actual roles through hands-on practice with real patient scenarios before go-live.
AI is useful for tasks such as drafting correspondence, but it does not resolve the foundational workflow gaps that cause most preventable revenue loss. Two-thirds of providers believe AI can improve claims processing, but only 14% currently use it to reduce denials.
Healthrise conducts an upfront on-site assessment, aligns clinical documentation with the revenue cycle, supports providers, provides at-the-elbow expertise and uses analytics to track adoption after go-live.
Jodie Hilliker is Senior Director of EHR Services at Healthrise, where she leads the firm’s clinical division and its work connecting patient care with the revenue cycle. She has overseen more than 425 Epic implementations.
