Hospital Charge Capture Solutions – Must Haves

Colleagues working in a call centre.
Hospital charge capture is an important focus for revenue integrity teams.

Is your hospital caught in a spiral of charging more for some services to compensate for other services with slender margins? How about confusion over hospital charge capture procedures?  We’ve seen this happen a lot at client hospitals before they get a complete handle on the charge capture process.  With smart charge capture solutions, not only can your revenues increase, but you also avoid expensive audits that can clawback revenue due to disputes and inaccuracies.

The challenge for hospital charge capture:  A recent article in HealthLeaders Media points out that, “Hospitals and health systems are facing an increasingly intense payment environment from all directions. Payers are creating more roadblocks to either limit or slow the pace of reimbursement, while patients strive to cover their costs and staff turnover subverts process improvement.”

Specifically, the article lists four areas of concern:

  1. More adverse payer strategies
  2. New rules for 2019 from centers for medicare & medicaid services
  3. Administrative work contributing to physician burnout
  4. Ensuring a high-performing workforce

“The payers are looking for opportunities to change the policy or find mistakes, but ultimately are trying to pay at a lesser amount than we would expect to be reimbursed.” — Abby Abongwa, vice president of revenue cycle at UW Health in Madison, Wisconsin

A lot of these concerns can be handled using a smart, up-to-date “Chargemaster”, or hospital charge description master. In a related article, RevCycle Intelligence emphasizes that “The hospital charge description master, or hospital Chargemaster, is at the heart of the healthcare revenue cycle, serving as the hospital’s starting point for billing patients and payers.”

And, an article at Becker’s Hospital Review on 10 ways hospitals can improve charge capture observes that “charge capture is a crucial part of the revenue cycle process, as healthcare organizations that fail to accurately document information on the care provided at their facilities can potentially lose millions in revenue.” The article goes on to list remedies including good communication, employee education, and investing in a charge capture system.

Healthcare revenue cycles always have room for improvement. The shift to value-based purchasing, declining claims reimbursement rates, and changing health policies are pushing hospital revenue leaders to find new strategies they can use to improve a hospital’s financial health. There are three must-haves for revenue enhancement: Having the Charge Description Master (CDM) up to date, ensuring there is accurate medical record documentation, and regularly auditing and monitoring. All three clinical data improvements are essential to achieving management success.

Three Revint Recommended Hospital Charge Capture Focus Areas:

  1. The Charge Description Master (CDM) must be up to date and include all the services provided with the appropriate price.
    • Are all your codes up to date, including bundled procedures?
    • Are services priced appropriately based on hospital policy and fee schedules?
    • Are procedures mapped to the appropriate revenue code?
    • Are all the services provided included in the CDM?
    • Are interfaces set up and mapped appropriately?
    • Who sets up and validates the CDM when the hospital offers new services?
  2. Medical record documentation must be comprehensive and accurate.
    • Is there a formal internal or external medical record documentation program in place?
    • How often is training provided?
    • Does the medical record support the billing for services?  If not, how do you fix the root cause of this issue?
    • Do you know how much revenue is lost due to insufficient medical record documentation?
  3. Auditing and monitoring must be conducted regularly.
    • How often are departmental audits conducted?
    • Are new physicians audited when they start?
    • How do you know if you’re not billing for services that are being provided?

Read more about Revint for charge capture here.

Revint is an industry leader in healthcare revenue integrity solutions and advisory services for healthcare providers. With more than 1,700 healthcare organization clients in the United States, Revint helps them recover more than $475 million a year in underpaid or unidentified revenue. Solutions include Transfer DRG, DRG Validation, Charge Capture, Underpayment Recovery, Medicare Reimbursement, Professional and Advisory Services.

Ever notice doctors capturing charges on spreadsheets, or even sticky notes? This is inefficient and hard to track. PMD, a company that offers mobile software for healthcare professionals, advises that, “the best and most efficient form of charge capture involves using mobile devices, such as smartphones or tablets. Doctors can record their charges using a charge capture application on their phones, allowing them to enter charges on the go. And because they can submit these electronically, doctors no longer have to shuttle paper charges back and forth from the hospital to their office.”

A combination of best practices, a comprehensive up-to-date hospital charge master, and efficient charge capturing will be a key hospital charge capture strategy for revenue enhancement at your facility.

Discover top trends affecting the revenue cycle – and how to address them –  with the 2023 Revenue Intelligence™ Data and Insights Report.