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In the era of digital transformation, most hospitals have adopted advanced electronic health record (EHR) systems to streamline care delivery and administrative processes. Among the most widely used platforms is Epic Systems, known for its robust, customizable workflows that span the patient journey from scheduling and documentation to billing and revenue cycle management. But even in Epic’s highly integrated environment, manual insurance processes remain a major source of inefficiency, denial risk, and financial leakage.
This blog explores the hidden costs of manual workflows within Epic’s insurance modules and why automation is no longer optional for health systems focused on sustainability and scale.
What Is Epic, and How Does It Work?
Epic Systems is one of the most widely used EHR software, used by over 2,000 hospitals and 45% of the U.S. population. It’s designed to provide a unified platform where clinical, financial, and operational workflows intersect. Within Epic, modules such as Benefits Engine, Coverage Discovery, and Real-Time Eligibility (RTE) help healthcare providers manage insurance verification, prior authorizations, and claim submissions.
However, while Epic offers automation features, many health systems still rely on manual interventions, whether it's staff entering insurance information by hand, manually verifying coverage, or reworking denied claims. These manual steps not only slow down operations but also introduce significant room for human error.
The Hidden Costs of Manual Insurance Workflows in Epic
Manual tasks in Epic, like eligibility checks, data entry, and claim corrections, may seem routine, but at scale, they cause major revenue leakage and operational delays. Despite Epic’s automation capabilities, many hospitals still rely on manual interventions that drive up costs and slow reimbursement.
Every unnecessary manual step adds risk: denials increase, Accounts Receivable (AR) days extend, and revenue gets trapped in rework. Even a single day in AR can cost hospitals thousands in working capital.
Operationally, manual workflows consume staff time, raise error rates, and delay patient access, all while draining already limited clinical and billing resources.
Why Manual Processes Still Persist in Epic
Despite Epic’s automation capabilities, like real-time eligibility checks and electronic prior authorization, manual work remains common. The reasons are often systemic:
- Inconsistent staff training on using Epic’s automation features effectively
- Custom-built workflows that don’t integrate well across teams, leading to workarounds
- High turnover rates that disrupt consistent system use
- Complex and shifting payer requirements, which are difficult to encode into standard EHR logic
The Cost Beyond the Balance Sheet
Manual workflows don't just cost money; they cost time, trust, and continuity. These inefficiencies:
- Slow down coverage verification, delaying care
- Increase administrative load on clinical and billing teams
- Lead to preventable denials, requiring costly rework
- Risk non-compliance when documentation doesn’t align with payer expectations
Studies show that clinicians can spend up to 16 minutes per patient visit navigating EHR tasks, much of it related to insurance workflows. This is time that could be spent on direct patient care, innovation, or quality improvement efforts.
How Modality Global Advisors Can Help
At Modality Global Advisors, we help hospitals turn Epic into the asset it’s meant to be, a tool for efficiency, accuracy, and sustainable growth. Our approach goes beyond technical fixes. We combine deep expertise in Epic optimization with a strong understanding of perioperative care, revenue cycle strategy, and workflow design.
We can partner with health systems to:
- Conduct end-to-end audits of insurance workflows within Epic
- Identify where manual work creates delays or denials
- Deploy automation tools and Epic-native solutions for key tasks like eligibility and authorization
- Train teams to use automation consistently and correctly
- Build dashboards to monitor workflow performance, denial trends, and financial outcomes
Final Thoughts
As financial pressures mount and margins narrow, hospitals must stop treating manual workflows as a necessary evil. With the right strategy, Epic’s tools can be leveraged to minimize administrative waste and maximize revenue accuracy.
But technology alone isn’t the solution; it’s how you use it strategically that drives outcomes. MGA is here to help you connect the dots between your systems, teams, and revenue goals so your EHR works with you, not against you.
Ready to unlock the full value of Epic’s insurance capabilities and stop the financial drain? Let’s talk.