Charge capture is a crucial part of the revenue cycle process, as healthcare organizations that fail to accurately document information on the care provided at their facilities can potentially lose millions in revenue.
Here, revenue cycle management providers offer tips on how to improve charge capture.
Healthcare organizations today can leverage virtually any healthcare information system and automatically drop a charge, says Dan Ward, senior vice president of strategy for ZirMed. He used the specific example of dropping a charge for an electrocardiogram off of either "ordered" or "read." When a hospital drops a charge for an EKG off of ordered, the organization has created that charge before it's completely certain the EKG occurred.
"So the doctor ordered the EKG and the patient could get tired of waiting or something else could come up. There, the EKG never happened, but the charge was dropped automatically at the point of order," Mr. Ward says. "Likewise if you dropped it at read you're essentially saying we're not going to charge until a physician actually reads, interprets and subsequently documents that. You could do the EKG and incur all the costs but if you have physician who isn't good at finishing documentation or the system is not conducive to them accurately marking that it was done then you may never drop a charge for something you have done."
Mr. Ward notes payer-specific rules, CMS rules and current procedural terminology codes change frequently. Therefore, with complex areas such as interventional radiology or interventional cardiology, it is especially crucial employees are up to speed. For instance, "Things you could charge for in August you may no longer be able to charge for in January," he says. These frequent changes require provider organizations to focus employee training around CPT changes, bundling and unbundling, according to Mr. Ward.
Mr. Ward says hospitals that are most successful with charge capture understand there has to be a true process bridge between what's happening clinically and what that's intended to engender financially. "That can be formalized with service line clinical representation at revenue cycle steering committee meetings, or it can be a lot less formalized where processes are solidified and reflected in the system," he adds. "But this mutual understanding of what your charge capture processes are and what charges do drop automatically, versus those that require someone interoffice mailing a piece of paper to someone in the business office so they can manually enter charges, is critical to ensuring minimal breakdown in charge capture."
Hospitals should establish central charging policies and guidance, said Kate Harper, vice president of revenue integrity at R1 RCM. She added: "Consistent charge structure and descriptions make it easy for people to understand from department to department and help each other out."
Ms. Harper said implementation of pre-and post-billing exception reports is vital, as it allows hospitals to identify data anomalies and exceptions that indicate potential missing or incorrect charges and codes.
Ms. Harper recommended hospitals develop a communications process to link teams that are part of charge capture, such as clinical departments, charge description master and billing. Additionally, she recommended organizations have interdisciplinary teams come together on a regular basis to discuss charge capture and to ensure missing and incorrect charges are identified.
Hospitals may use various standalone applications and EMR integrated solutions to appropriately identify and capture charges, according to Sondra Akrin, vice president of revenue cycle transformation at Hayes Management Consulting. "Without these solutions, many organizations have to rely on archaic, paper-based methods of capturing charges," she said. "These applications should have functionality that allows an organization to quickly identify what has been billed, what is 'missing' or unbilled, [and] methods for checking the accuracy and completeness of the billing."
Ms. Akrin said hospitals can ensure they have correct charges for each patient by performing regular billing audits using patient census, emergency department and admission/discharge information. She recommended hospitals conduct an audit for services that should have a technical and professional component (i.e. radiology) to ensure both charges were reported and accurately billed.
Hospitals should also identify charge capture processes for multiple streams of revenue, such as acute, ambulatory, pharmacy and ancillaries, Ms. Akrin said. She added: "Make sure you have workflows that ensure the right charge is identified at the right time, whether a technical and professional component is accurately reported/needed, [and] appropriate 'safety nets' to ensure the billing and coding are appropriate and accurate."
This includes lag times from date of service to billing/coding and lag times from service date to posting date and claim submission, Ms. Akrin said. She said hospitals should also compare their lag times to industry benchmarks to identify problem areas.