Ask a practice leader whether their technology works and you will hear about the implementation. Ask whether staff route around it and the picture changes immediately, because the workaround is the honest answer no vendor demo ever shows. A July 21 MGMA Stat poll found 75 percent of medical groups say clinicians frequently (43 percent) or sometimes (32 percent) use workarounds for EHR and practice management system issues. Only 3 percent say workarounds never happen.
The listed workarounds read like a denial preview. Respondents pointed to documentation, order entry, referrals, prior authorization, and lab workflows - with one practice keeping a Teams spreadsheet because the EHR cannot track authorization, scheduling, and results as a single workflow. Medical assistants surfaced repeatedly, absorbing duplicate entry and manual reconciliation that never gets recorded as a system failure. It is recorded instead as overtime, turnover, and eventually as claims that go out wrong.
How a workaround becomes a denial
Workarounds feel harmless because each one solves today's task. The revenue cycle sees the downstream bill:
- The spreadsheet that tracks authorizations has no deadline logic. When the reminder depends on someone opening the file, the expired auth becomes a denial nobody saw coming.
- Paper captured before EHR entry duplicates every field. Demographic mismatches and wrong payer IDs - the most preventable denial categories - are born in that second keystroke.
- Referrals routed around the system lose their attached documentation, and documentation gaps are where medical-necessity denials grow.
- Reconciliation done by hand means payments posted late or wrong, which corrupts AR aging and hides the accounts that actually need follow-up.
MGMA's point that this work is "absorbed into daily operations rather than recorded as a system failure" applies with interest to billing: the workaround's cost is never booked as rework, so it never competes for a fix budget. It just quietly sets the denial rate, one spreadsheet and one fax at a time, while the practice wonders why its first-pass yield never improves.
Fixing the layer the EHR will not
Waiting for the next EHR upgrade is not a plan; the same poll shows problems spanning configuration, interoperability, and upgrades across every major product. The pragmatic sequence:
- Inventory the workarounds. Ask staff what they do when the system gets in the way. The list is the map of where denials and AR delays originate.
- Triage by revenue exposure. Authorization tracking and referral documentation touch the highest-value claims; start there, not with cosmetic fixes.
- Put deadline logic outside human memory. Whether the fix is system configuration or automation, auth deadlines and status checks cannot live in a spreadsheet someone remembers to open.
- Measure the drift. First-pass denial rate by workflow tells you whether a workaround is a nuisance or a leak. Anything feeding denials is not a nuisance.
There is an organizational argument to make alongside the operational one. Workarounds concentrate on the least senior staff - the medical assistants absorbing duplicate entry and manual reconciliation in MGMA's findings - which means the people with the least authority to change the system are the ones paying its tax daily. Surfacing that cost to leadership, with the denial data attached, reframes the workaround from a staff quirk to a governance issue. Budgets follow governance issues; they rarely follow complaints about clicking.
MGMA's poll also noted that even practices reporting rare workarounds cited outages, authentication requirements, and prior authorization as occasional sources of extra work - meaning the true baseline is not 75 percent but effectively everyone. The question is not whether your organization has workarounds; it is whether anyone has counted them. That count, paired with the denial and AR data downstream of each workaround, is the business case for the fix, and it usually writes itself once assembled.
The takeaway
A 75 percent workaround rate is not a staffing failure - it is the honest response of capable staff to systems that do not match the work. But every workaround in the front office is a denial, a delay, or a posting error somewhere downstream, and the cost never shows up labeled as such. Mapping the workarounds and closing the revenue-facing ones is the cheapest denial prevention available. It is also exactly the layer QHB replaces: agents that track authorization from order to outcome, chase statuses daily, and keep the queue out of spreadsheets entirely.