Are Hospital Charge Capture Best Practices Followed?

Mis-coded charges continue to paralyze revenue integrity at hospitals. We’ve written about hospital charge capture solutions in the past, and most revenue cycle teams agree that this is important. So why do hospitals continue to miss some key opportunities to focus on charge capture?

From recent survey results, it looks like a majority of revenue cycle leaders at acute care organizations surveyed find charge capture “essential” but discuss it infrequently even though they note that physicians and coders need to communicate better.

RevCycle Intelligence reports that in a survey involving 104 leaders who oversee the revenue cycle at acute care healthcare organizations representing 35 states. Six findings:

1. Most respondents (78 percent) said charge capture is essential to their organization’s success.
2. Forty percent of respondents said they talk about charge capture once a month or less, and only 8 percent said they discuss it daily.
3. Most respondents (84 percent) rely at least partly on their EMR/EHR systems for charge capture, and 50 percent use it as their sole charge capture solution.
4. Forty percent of respondents said physicians and coders should be equally responsible for accurately capturing charges.
5. Fifty-three percent of respondents said their coding department spends 10 percent to 25 percent of their time tracking down information from physicians.
6. Healthcare executives cited missing charges and charge lag as the top two charge capture challenges.

It looks like findings #4 and #5 get directly to a major opportunity to solve the problem. If physicians need to share responsibility for charge capture, but coding departments have to track them down for more information, then data input solutions seem to be very important. We hear this from a number of our client hospital teams and are pleased that our own hospital charge capture solutions include both retroactive and proactive remedies.

RevCycle Intelligence shines more light on the hospital charge capture situation with this analysis of results: “Revenue cycle leaders identified their EHR [Electronic Health Records] systems as a major charge capture challenge. Specifically, they cited a lack of integration between EHRs and other technologies. EHRs are the dominant health IT system used for charge capture, according to the survey. One-half of revenue cycle leaders said they exclusively use the EHR to capture charges, and 84 percent of all respondents rely at least partly on their EHR system for charge capture. Standalone charge capture solutions exist, but just 28 percent of participants used an electronic, standalone product. The remaining 27 percent still use manual processes to capture charges.”

Tracking down doctors for information; integration of EHR systems; lack of discussion by managers all contribute to the charge capture problem hospitals face. Healthleaders Media has an article that focuses on three areas to improve the situation.

Reviewing the same survey data, the editors reached out to one of the leaders that took the survey, Eduardo Medeiros, CFO of SUN Behavioral Health in New Jersey. His take:

“It is surprising to me that on average, organizations are discussing charge capture only once a month or less. To me this is a critical piece for organizations to ensure the accuracy of their revenue. Charge capture should be monitored regularly, much more frequently than once a month.”

The article pulls out three take-aways that we believe will be very helpful:

• Monitor charge capture regularly to ensure revenue accuracy.
• Provide physicians with training and performance metrics to improve coder efficiency.
• Prioritize charge capture with a team-based approach and regular audits.

Of course, charge capture involves a number of other practices including creation of a chargemaster — a comprehensive listing of items billable to a hospital patient or a patient’s health insurance provider — which in turn plays a role in negotiating contracts and payments with payers. As we continue to work with over 1,600 healthcare organizations in the U.S., we’ll keep reporting on hospital charge capture solutions.