Three Charge Capture Process Tips to Increase Revenue: The Best Defense is a Good Offense

By Kevin Smith, Vice President, Product Management | Posted: 07/17/2018

Charge Capture

According to the Healthcare Financial Management Association, “one percent of net patient revenue is lost due to charge capture errors. Despite perceptions that charges don't 'matter' in a value-based payment, it is important to continue to focus on charge-based reimbursement as a salient portion of hospital revenue cycle.”

Money down the drain

Many health care providers don’t factor the millions of dollars slipping away when failing to charge for care services or supplies owed for reimbursement. Perhaps the issue is masked by the many challenges that health care providers find themselves facing: a continually changing climate in Washington DC, increased coding complexity, and lower medical payor reimbursement levels.

Quarterly regulatory updates and value-based reimbursement models that tie the patient experience to financial results add to the pressure; especially as patients who are responsible for higher deductibles are increasingly demanding more information on what it will cost. Reduced or limited staff resources raises the hurdles for health care providers – though the stakes are high, it’s difficult for even the best employees to maintain expertise in all areas of compliance and morphing business demands.

The expression, “you don’t know what you don’t know,” aptly describes what health care providers face as they try to collect the revenue they’re owed. Many realize they aren’t capturing all patient charges, so they conduct self-audits or spot checks to catch the big mistakes. But with the thousands of possible clinical scenarios and lack of an airtight patient billing process facing them, health care providers cannot possibly keep up. The result is millions of dollars lost in missed charges, overcharges and noncompliance errors that can threaten financial viability.

Some charge capture problems can be corrected with claims scrubbing software and by conducting internal audits, but their impact is limited.

Three tips to guard the yard

The best defense against charge capture errors is a strong Charge Integrity strategy. It provides a billing safety net that your health system can count on to capture revenue, increase operational efficiency and improve billing compliance. The more comprehensive your reimbursement strategy, the more effective the results.

These tips won’t make your Charge Integrity program do a 180 ̊ turnaround immediately, but they could contribute to charge capture improvements.

  1. Use health information management technology to automatically review charges before the bill goes out, if not before then do a post bill review.
  2. Build consistent communications standards
  3. Cut lag times. From date of service to billing and from service to submitting claims, there may be opportunities to close the time gaps. Efficiency is key.

Implementing a more comprehensive Charge Integrity strategy that comprehensively cleans up your program is a larger undertaking and requires extra staff resources with the expertise and experience to develop the entire program quickly.

Add a partner to your team

One of the most efficient approaches to quickly implementing a strategy that produces lasting results is to engage a revenue cycle vendor partner that provides thorough management of the charge capture audit process. They help your health organization compile complete bills that recognize revenue for all services rendered – identify charge issues throughout the revenue cycle, fix issues pre-bill and prevent costly billing rework and late charges.

Seek the help of a partner that can:

  1. Perform reviews of current programs and implement best practice processes to speed compliance with ongoing regulatory changes
  2. Audit 100% of bills to identify missing charges, overcharges, and medical coding errors.
  3. Educate staff based on identification of problematic trends upstream in the revenue cycle management process to prevent future errors.
  4. Implement technology to automate existing manual processes.
  5. Provide resources to augment staffing with credentialed subject matter experts to tackle the project.

Strong to the finish

If your health care organization operates without a billing safety net, you risk millions of dollars in revenue, productivity and compliance. A strong partner with Charge Integrity expertise and supported with an entire bank of solutions, from Patient-to-PaymentSM, can automate billing review and resolution processes, bring issues to the surface and resolve them permanently.

Kevin Smith, Vice President of Product Management

In this role, Smith leads the Patient Access Product Suite, including the industry-leading CarePricer and Charge Integrity product suite, and is responsible for the full product life-cycle management of these solutions. 

Smith joined nThrive in 2012, bringing 20 years of experience in product management, strategy, and technology to his role, having held positions at Intel, Dell, and most recently Fiserv before joining nThrive. 

Smith is a graduate of Kelley School of Business at Indiana University with an MBA and bachelor’s degree in Finance. He is also a certified HFMA Revenue Cycle Representative.