Charge capture is critical for success for every healthcare organization that seeks reimbursement for their services from insurance companies. If the services are captured on the reimbursement form, then the clinician or facility simply won’t get paid for those services, which results in lost revenue. If the services are captured in a way that doesn’t fully codify the variety or complexity then the reimbursement may result in an underpayment for services delivered. Finally, if the medical coder overstates the types of services delivered, the organization could be at a risk for overpayment which can cause significant issues downstream if and when the insurance company requests an audit.
Charge capture often feels like a never-ending exercise of whack-a-mole given how hard it is to do it consistently. However, its importance seems to be downgraded when it comes to improving or evolving it. A new study from Ingenious Med found that 78 percent of healthcare leaders identify charge capture as essential to success but that 40 percent of organizations were found to talk about the process once a month or less. This suggests that communication within healthcare organizations is lacking in regards to charge capture, with the result that hospital charge capture best practices may not be regularly employed.
Medical technology companies should pay attention to the challenges and opportunities that their hospital clients face related to charge capture. After all, if the hospital’s medical billers and coders can’t appropriately capture charges related to the service or procedure you are selling, then the realization of your technologies Return on Investment (ROI) is at risk.
Charge Capture Processes Vary
Charge capture is the process that medical professionals use to get paid for their services. So, of course, it’s critically important to them. Charge capture requires these clinicians to document in a clear, consistent and descriptive way so that their medical billers can “code” the correct diagnosis, to the appropriate level of detail, AND capture all the relevant procedures delivered so that this important information can be relayed to the payer for reimbursement.
Medical coding itself is universal, with every type of physician and facility employing specialists trained in the translation of clinical documentation into insurance claims described using the alphabet soup of healthcare codes. However, the underlying operational processes by which physicians and other medical providers record and transfer clinical information to their medical billers varies. Some use paper-based systems most have transitioned to relying on digital and other electronic means for handling these administrative processes.
84 percent of organizations surveyed in the study were found to rely at least somewhat on the EMR or EHR system, but respondents noted problems with it. Additionally, 28 percent of providers surveyed use electronic means only while 27 percent use paper exclusively.
To ensure that charge capture is carried out in the most efficient way, healthcare organizations would benefit from innovating to use important best practices.
Charge Capture Challenges
Having multiple systems, and using a hybrid of digital and paper processes, lead to the biggest challenges which the Ingenious Med Study pinpointed as:
- Missing charges
- Charge lag
- General inefficiency
- Integration with EHR
- Coding errors
- Adoption adherence
Hospital Charge Capture Best Practices
Given the complexities in the charge capture process, it should come as no surprise that operational gaps emerge and problems persist which prevent the organization from fully realizing the revenue they are owed for the clinical services delivered. Organizations have the ability to optimize their charge capture processes by adopting some, or all, of these best practices.
Optimize with Technology
There are simple methods to capture clinical data and transfer that information to a medical biller to properly code the diagnoses and procedures, and get the information submitted to the right insurance companies. Leveraging technology, and eliminating paper, will immediately create greater efficiencies and set up your organization for related tracking and auditing procedures. Plus, with technology you can more consistently modify and update charges when needed (and importantly create a defensible audit trail), which will clear uncertainty.
Educate to Overcome Adoption Issues
As with any system, if all the stakeholders involved in the process (from the clinician delivering care to medical assistants or scribes capturing data to administrators involved in capturing demographic and insurance data) don’t fully understand the charge capture process and the critical importance of each step in that process, there will problems. Staff need to be educated on why charge capture matters because without a consistent process, insurance claims won’t go out in a timing matter, may under or over capture the services delivered or simply will result in the team not getting paid.
It’s vital that staff do not wait on officially coding procedures as this could cause even more problems. For example, the contract with the insurance company may stipulate that if new charges are not submitted in a timely matter or corrections to denied charges are not addressed within the proscribed timeframe, then the hospital may lose out on that revenue. There are frequent changes in coverage so providers need to understand the importance of following the rules closely.
Document the Process
Hospitals are most successful with their charge capture process not only when it’s well-communicated and all stakeholders are educated, but it’s critical the process be well-documented. Further, having central charging policies and guidance established and documented will remove room for error and improve consistency as new team members join the team and pick up where others leave off. Charge capture is not always a one-and-done process, instead, think of it as the bi-directional flow of information among many constituents. A well-documented charge capture process ensures that all providers are following the same process. Also, when new clinicians come on board, the documentation can be provided as part of their onboarding process.
Use Tech to Catch Pre- and Post-Billing Exceptions
Using a technology platform to catch exceptions will remove some headaches. The hospital can then use this data to find anomalies and exceptions so that correct codes can be added or selected the first time around, getting billing moving through the process — instead of stuck in purgatory.
Audit the Process Regularly
One of the fundamental activities a hospital must do with charge capture is audit their billing on a regular basis. This will ensure that the correct charges for each patient were submitted. Not only should standard billing be audited, but it’s also a good idea to look at services that have both a technical and professional aspect — like radiology — to check that both codes were inputted into the system.
Examine Lag Time Challenges
Charge lag was number two on the challenges list and it continues to be a problem. However, it can be remedied. Hospitals can look at lag time between all major steps in the process such as from the date of service to the date of claim submission to the date the claim remittance advice was received to the date the claim was finally paid and try to determine where bottlenecks arise. That information can be used to compare their times to industry benchmarks, which will let them know understand charge their lag and what area of the process needs improvement or intervention by management. By going deep into the data, and also considering what the process currently is, professionals should be able to find ways to shorten time delays.
Charge capture is vital to a hospital’s financial health, yet so many struggle with executing a repeatable, high integrity process. Whether you are selling services and solutions to tackle this critical process within the hospital, or if the ROI for your technology simply relies on a strong charge capture process, make sure you add this topic to your list of sales qualification questions. This area is clearly ripe of improvement and introduces an excellent conversation starter.
Hospitals need innovative technology to bring their charge capture process into the 21st century. As a provider of solutions to healthcare, you may be able to help hospitals with their charge capture process. Or by asking how it will impact their ability to adopt and get paid for your new technology or procedure, you will show how your company is more than just a vendor but rather a partner in the hospital’s success. Helping hospitals overcome charge capture challenges is a win-win for both the hospital, which can collect billing faster, and your organization.