An ineffective charge capture program leads to revenue leakage and delays cash realization. While most organizations focus well on back-office functions such as A/R and denial management, they fail to give due attention to the effectiveness of the charge capture process. Missed charges and inaccuracies in charge capture are the primary causes of ineffective charge capture.
Underlying issues in charge capture
When clinicians, charge capture team members, and Charge Description Master designers work cohesively, the quality of charge capture improves. However, this is easier said than done. We look at the role of the three key stakeholders in the charge capture program below:
Charge Capture and Back-office teams. Hospitals, healthcare systems, and physician practices miss charges because of incomplete clinical documentation, leading to an increase in Discharged, not finally billed (DNFB). While efficient coders may be able to identify such undocumented procedures, an effective revenue leakage identification exercise requires the involvement of charge capture, coders, and clinicians. Ineffective documentation can also lead to increased denials, variances in payments, and increased workload of rejections management teams.
Physicians and their understanding of billing processes. In smaller practices, physicians rely on super-bills; hence, the exercise of charge audits with coders can effectively identify gaps in their knowledge of the clinical documentation requirements. In hospitals and emergency departments, due to the number of clinicians involved, the problem becomes even more complex. Periodic physician education sessions can help identify any issues in clinical documentation and improve coding and billing effectiveness. It is essential to recognize that billing and coding guidelines change quickly, and periodic information exchange enables revenue cycle team members to get physicians up to speed.
Charge Description Master Teams. If your CDM team members have limited knowledge of the services provided, you are likely leaving revenue on the table. A good CDM team should include finance leaders, the chargemaster director, billing personnel, coders and staff with clinical knowledge, and finance staff. The CDM team's responsibilities must include gathering reviews, updating codes, assigning revenue codes, reviewing any changes in codes and rates, and identifying services where the charges are below the Medicare rates. The team must work with clinicians to ensure the chargemaster has all the billable procedures for the services in high demand. By working with coders and billers, the CDM team can play a critical role in aligning coding practices with the chargemaster to reduce instances of missed charges and arrest revenue leakage.
Importance of Quality Control in Charge Capture. Most in-house revenue cycle teams work on the assumption that the captured charges are accurate. While that may be true, it's better to have a centralized audit team to review the quality of charge capture and ensure high accuracy.