Charge capture is a process practiced by healthcare providers to get paid for their services. In this process doctors record information on the services rendered which is then submitted to insurance companies for reimbursement. It is widely used by hospital groups; consulting specialists; ophthalmologists, surgeons, and other specialists who see patients in healthcare centers, and document the diagnosis and procedures at point of care.
In recent times, the capture of appropriate charges has become more challenging. This is because, with the passage of time, numerous variables have come into being, each of which has added to the complexity of the process. This has led to issues such as missing or incomplete documentation, obsolete knowledge of what can be charged, ignoring, or overlooking unbilled services, incomplete updates to the Charge Description Master (CDM), inconsistent charging practices, improper reconciliation, changing payer guidelines etc.
| Tips to Keep a Check on Charge Capture Errors A detailed analysis of claims for incorrect or missing charges Identify potential areas of charge-capture breakdown Evaluate internal-workflows for detecting, correcting, and monitoring missing and late charges Resolve issues that commonly lead to incorrect or missed charges/codes from the CDM |
More often than not, healthcare practices have fallen prey to these issues and have got their bottom line impacted. A recent Modern Healthcare report has found that providers are losing about one percent of their annual net revenue due to charge capture related issues. When translated into figures this adds up to a loss of up to $10 million annually for hospitals with an annual net revenue of $1000 million.
| Did You Know The most commonly identified charge capture issues are missing charges; charge lag; and coding errors. This is attributed to outdated rules; absence of technologies; lack of communication and no billing audits. |
Few Proven Ways to Improve Charge Capture Process:
Train Employees About Rules and Regulations
Frequent changes to payer rules such as CMS rules and current procedural terminology are a big problem for healthcare staff. By the time they adapt to a new set of rules, yet another set of rules are likely to replace them. This can be particularly difficult for those who work in areas like interventional cardiology or radiology. Given that changing rule is an evil that cannot be wished away, the best way to get control over it is to train employees routinely on changing rules on areas like bundling, unbundling and CPT changes.
| Did You Know About 1/3rd of healthcare providers say they can capture charges within 24 hours of service; 1/4th say it takes 1-2 days percent; 1/3rd say it takes 3-7 days, 6% say they require over a week. |
Document Processes End-to-End
Hospitals having a robust charge capture process owe it to their success in documenting flows end-to-end. Such documentation entails registering exactly what charges need to be captured and what needs to be dropped automatically. Furthermore, it helps to define specific roles and responsibilities for chargecapture and reconciliation. Such a process helps to find ways to nip issues and thus prevent a breakdown in charge capture. Some hospitals even have processes that are embedded into their system through technology thereby leading to less errors.
| Did You Know The report found that 40% of respondents believed coders and physicians should be held equally accountable for capturing charges. But 31%wanted doctors to be more accountable and 19 percent were of the opinion that the responsibility rests more with coders. |
Have Same Charge Standards Across Departments
Hospitals must have central charging policies. This is of crucial importance to effective charge capture because a standard charge structure and description makes it easy for all stakeholders to have a correct understanding of charges. With a centralized charging policy, it is possible for employees from different departments to help each other out.
Leverage IT systems
This is arguably the best option. Customized IT solutions can automatically drop charges whenever possible. Likewise, technology can help to catch pre-and post-billing exceptions. Implementing pre-and post-billing exception reports is important for hospitals, as it allows them to identify exceptions and data anomalies that point to potential missing charges or wrong charges and codes.
| Did You Know A report on charge capture solutions found that nearly 28 percent of providers used a standalone electronic product. About 27 percent still depended on manual processes to capture charges. |
Build Regular Communication
A good communication process helps to set up proper coordination between teams that are part of charge capture. These teams commonly include clinical departments, charge description master and billing. A recorded communication through mails is good to establish accountability. Having the interdisciplinary team looped in the communication process can also be helpfulas they can keep a close eyeon the charge capture process and ensure incorrect and missing charges are identified.
Invest in a Charge Capture System
The archaic, paper-based methods of capturing charges is prone to error and delays. Nowadays hospitals bank on different types of standalone applications some of which are integrated with the EMR to appropriately identify and capture charges. These solutions come equipped with functionalities that helps in quickly spotting what has been billed and what is missing. Besides, these solutions also help in checking the completeness and accuracyof the billing.
Carry Out Routine Billing Audits
Hospitals must conduct an audit of billing services regularly. And the audit process must have a professional and technical component to ensure charges are reported correctly and billed accurately. The audit needs to be carried out in departments which matter the most such as emergency department and admission/discharge departments. The 2 big benefit of routine audit is spotting the root-cause for charge capture variances and determine the best remediation process to resolve existing issues and prevent issues from coming up.
| Did You Know About 56 percent of hospitals were audited by CMS or other payers more than once. |
Evaluate Billing Workflow
Hospitals need to have an integrated system for identifying charge capture processes for all streams of revenue which includes ambulatory, pharmacy, acuteand ancillaries. A well-developed workflow will ensure that the right charge is identified at the right time. Likewise, it will ensure that a professional and technical component of charge capture is reportedaccurately. Additionally, a good workflow will put in placethe best safety nets to make sure that the coding and billing are correct and accurate.
| Did You Know According to the report nearly 68% of revenue cycle leaders found that between 1 and 10% of their charge capture was under-coded, and 20% believed that 11 percent or more of their charges were impacted by under-coding. |
Review Lag Times
Lag times have a big impact on charge capture. If there is huge lag then the consequences can be irreversible. Therefore, it is important for hospitals to have control over it. The best way out for hospitals is to compare lag times to industry benchmarks. A comparative approach helps to identify all problem areas leading to lag times. Lag times need to be reviewed from service date to billing/coding as well as from service date to posting date and claim submission.
Who We Are and What Makes Us an Expert?
This article is brought to you by MedBillingExperts, a specialized health BPO service provider catering to the needs of healthcare providers based in the US. We have wide experience in medical billing and coding services and understand it deep enough to assist you identify and quantify the root causes of inaccurate charging and eliminate them. Our robust process has helped our clients bring about long-term improvement and focus on quick wins removing all hurdles to profitability. To know more about our services, get in touch with our experts now.
