Overview
Efficient, timely, and accurate billing should be the lifeblood of any organization. Medical practices are no exception. Healthcare providers, like any professional, deserve to be fully compensated for the services provided. In the medical world, the process of getting paid is referred to as charge capture.
Medical industry leaders agree that efficiently recording and submitting data about patient interactions to payers and insurance companies is crucial. But a phalanx of insurance regulations, lax collection efforts, and underperforming software serves to make achieving revenue goals almost impossible. Even more damaging is that the majority of healthcare providers think about charge capture just once a month or less.
While attention is often centered on revenue cycle management, it is surprising that charge capture seems to evade scrutiny. Even a few small changes in this area could result in an impressive return on investment. Accurately capturing an additional $100 a day in missed or under-charges could result in over $25,000 in increased annual revenue. This article looks at charge capture solutions that can help to improve the charge capture process.
What is the Charge Capture Revenue Cycle?
The simplest explanation of charge capture is that providers record information on patient interactions, and bill for those services. But, the reality is far more complex than that. A typical charge capture revenue cycle might look something like this:
- Interaction: A doctor or medical provider has an interaction with, or on behalf of, a patient. This may occur as an in-person visit, telemedicine session, phone call, or response to an online patient portal inquiry. Whatever the form, the healthcare organization should be compensated for time expended on the patient’s behalf.
- Notation: This is where the process gets tricky, as the provider must provide detailed notes about what happened during the interaction. Sometimes these notes are hastily jotted on paper forms, and later translated into the patient record. Any services not noted at this time are not submitted for payment, thereby resulting in lost revenue opportunity. A better approach is to seamlessly integrate EHR workflow with Revenue Cycle Management (RCM) services into a simple, single source.
- Coding: These notes are assigned billing codes, which are then translated into charges and submitted to the various payers. Paper notes, however, may be lost or illegible. An outdated EHR may not sufficiently annotate chargeable services in complex or multiple diagnosis cases. The danger lies in inaccurate coding, undercharging, or overcharging, which can result in missed revenue or denied claims. In cases of CMS payment, compliance issues are particularly critical.
- Resolution: The best outcome would be prompt payment of all claims at the maximum allowable rate. In cases of error or discrepancy, immediate follow-up is required to resubmit an amended claim in the least possible time.
Challenges with Charge Capture
The biggest challenge in charge capture is providing an accurate flow of reliable information. The provider needs to accurately track and document actual services. This information must then be translated to actionable billing codes. If the process is flawed, the provider’s time is not properly compensated. Staff may end up having to track down missing information.
While the optimum is to capture charges within 24 hours, coding personnel often spend an inordinate amount of time filling in documentation gaps. This can result in unnecessary billing delays and increased claim denials. In addition to charge lag, other charge capture challenges include:
- Not charging for all services provided.
- Inefficiency in the information flow process.
- Lack of understanding regarding the importance of accurate charge capture by medical providers.
- Insufficient training of coding and billing personnel.
- Poor integration with EHR software.
- Coding errors and omissions.
- Inattention to payer regulations.
- Lack of compliance with government regulations.
How to Improve the Charge Capture Process
To improve the charge capture process, healthcare organizations need to focus more time on this topic. Providers should be aware of its importance to revenue. Office billing personnel need to be trained on the importance of accuracy and timeliness. Key improvement steps in the charge capture process include:
- Electronic Health Records: Utilize robust EHR software with a customizable workflow designed for your practice. Create custom templates that promote the practice of documenting all activities.
- Revenue Cycle Management. Integrate RCM software which allows physicians and staff to handle everything from pre-registration to creating the submission of a claim via ICD-10 codes (which guide reimbursements for specific treatments), and complete charge capture duties, which translate documentation into billable fees.
- Providers: Place emphasis on accurate notation and explanation of services as they are provided. Use electronic means to eliminate legibility concerns.
- Coders: Improve adoption levels, and stress coding accuracy to maximize revenue, and minimize the potential for denials due to coding errors.
- Documentation: Carefully document the organization’s charge capture process so that all stakeholders understand their role. This reduces errors, and enhances consistency as new members join the team.
Charge Capture Best Practices
Leverage today’s state-of-the-art technology to efficiently capture clinical data, transfer that information for coding, and submit claims quickly to the insurance providers. Best practices that enable medical providers to take maximum advantage of charge capture improvements include:
- Responsibility: Assess equal responsibility for charge capture between providers and coders, and make it part of the annual review process.
- Charge Lag: Set a target goal of capturing charges within 24 hours (if not less) of the patient interaction.
- Claims Submissions: Work towards a target of 4-7 days between charge capture and claims submission.
- Claims Denials: Strive for a denial rate of less than 5% based on billing and coding errors.
- Resubmissions: Resubmit denied claims within 48 hours.
- Unpaid Claims: Review all unpaid claims within at least 30 days.
- Practice Focus on Charge Capture: Make one person responsible for achieving charge capture goals, and collect data to document any progress made. Hold scheduled monthly meetings to review revenue analytics, and discuss any changes necessary to improve results.
How Charge Capture Can Affect Healthcare Administrative Costs
Charge capture is the key to a healthcare organization’s success in many ways. It maximizes revenue potential by allowing providers to be fully compensated for services provided. They can focus on patient care without worrying about the billing process.
Administrative costs can be reduced by improving communication between providers and staff. Coding departments often waste up to 25% of their time simply tracking down additional information from providers. This is inefficient and frustrating. With a better process in place, everyone starts working together towards the same goal of getting the job done right the first time.
Correct coding also eliminates the stress and resources involved with a potential audit. Instead of worrying about what was done in the past, team members can focus on continuing to perform the current job correctly. Most importantly, charge capture leads to an improved cash flow by increasing claim success.
PrognoCIS by Bizmatics delivers a customizable, tailor-made workflow with rich and specialty-specific content for medical clinics. It offers a cloud-based EHR which streamlines workflows through a platform of stable and mature modules and features which includes Practice Management, Medical Billing, Revenue Cycle Management, Telemedicine, Patient Portal, and e-prescription.
Visit the website or call 408-873-3030 to request a demo, and learn more about charge capture solutions.
