5 Charge Integrity Tips to Transform Your Health Care Organization in 2019

By Mark Boudreaux, Director Product Management | Posted: 06/27/2019

nThrive charge description master tips

What Charge Integrity improvements or considerations in 2019 could transform your revenue cycle?

Here are the top 5:

  1. Charge integrity is key to ensuring that all dollars the health care organization is entitled to are captured in a compliant manner.

    There are 2 areas where your health care organization can make improvements that will help cut costs and make revenue cycle management improvements:

    • Verify the integrity of your charge description master. If the chargemaster is incomplete, out-of-date or noncompliant, you could be missing opportunities or even face penalties.
    • Implement a charge capture audit strategy to ensure that everything you did for patient care, including supplies and pharmacy, are accurately captured and charged to the patient.
  2. In 2019 Price Transparency* continues to evolve. Top health care organizations know to continue to improve on the standards.

    The ruling that requires health care organizations to post their prices in a machine-readable format raises new considerations going forward. Ask yourself these questions about the current state of your Price Transparency initiatives.

    • Is your chargemaster defensible? This has always been a concern for health care organizations, but public scrutiny intensifies the need for accuracy. A line-item review of your entire charge description master ensures that it reflects costs and resource consumption.
    • Is your pricing strategy competitive? As patients become consumers that shop for the best value in health care, understanding your health care organization’s market position is critical. To help improve the patient experience, boost patient satisfaction, and provide competitive and accurate pricing, look at custom benchmarks developed from proprietary and CMS public domain data to help you compare your prices with others so that you understand where you stand in the market.
    • How do you go beyond an Excel spreadsheet for your machine-readable pricing format? To increase patient satisfaction, provide an accurate estimate of services with nThrive patient bill estimation technology.
    • Empower patients to create their own quick and accurate estimates on a user-friendly platform.
  3. Patient consumer reliance on physician offices and urgent-care centers is increasing as health care costs go up. For health care organizations with large professional components, the shift is impacting revenue integrity and overall financial outlook.

    • There is a need to include the total continuum of care – not just the acute setting. Volumes on the professional side are dramatically higher. Vendors must adapt to this shift – innovation is key. For example, an upcoming enhancement to CCA Professional will leverage machine learning AI, which helps review for missing charges in a more efficient manner.
    • A contract management solution for the professional setting that accurately calculates what health care organizations should be reimbursed is critical. Although individual bills may be small, the volume makes managing small variances crucial.
  4. The EHR community has changed over the years. Health care organizations must adapt to work with the EHR community.

    • The goal is to achieve very tight integration between a charge integrity vendor and the EHR vendor. Streamline redundant workflows, including the need to access both systems. For example, notes entered in the EHR can interface with nThrive charge capture audit technology. Without integration, a team member may have to enter the same notes twice. One organization’s team lead noted that after they integrated Charge Capture Audit with their EHR, not having to log into two separate systems freed up approximately 20 hours a week that her team could focus on other tasks.
  5. Having a single revenue cycle vendor that provides value across all areas is critical because the vendor leverages data and capabilities to be implemented across the revenue cycle.

    • Contract management: Loading all your contracts with one vendor that can calculate with high accuracy your expected payment, as well as the patient bill is a critical capability. These calculations drive price transparency to the patient while identifying the value of missing charges during a charge capture audit. With nThrive, you can ensure your health care organization is appropriately reimbursed.
    • Chargemaster: The charge description master is the main source of truth for health care organizations. If the chargemaster is not managed with defensible accuracy, the organization does not get paid. The CDM fuels price transparency and reimbursement.
    • Charge Capture: Without an effective charge capture, health care organizations risk losing a lot of revenue due to inaccurately documented information, failing to charge for care services or supplies owed for reimbursement.
    • Claims Management: Few areas of the revenue cycle impact speed-to-payment as much as a strong claims processing system. The best solutions produce claims that result in full reimbursement, are compliant with Medicare and payors, integrate with Patient Accounting Systems (PAS) and provide visibility across the revenue cycle. nThrive offers software that prevents incorrect billing, accelerates incoming cash flow, reduces cost to collect, mitigates audit risk and empowers process improvement to produce good results in little time.

Collaborating with one vendor, versus multiple vendors, makes for a more integrated, streamlined process and helps a health care organization maximize results. Enhance your revenue cycle management from front to back with the nThrive suite of proven patient to payment solutions.

Contact an nThrive expert today by emailing us at info@nthrive.com and mention Charge Integrity.

*On June 24, President Trump signed an executive order on price transparency in health care that aims to lower rising health care costs by showing prices to patients. nThrive will provide more information on this topic as details become available.