Proper charge capture processes are essential to compliance regulations. An outdated, non-existent, or poorly thought-out charge capture workflow can be devastating to a hospital and healthcare system’s bottom line. Overcharging can be just as harmful as undercharging for medical services. The key to appropriate charge capture processes has shifted from a solely antiquated back-end operation to a newly recognized front-end operation of the revenue cycle. This article explores various approaches to charge capture, reason for inaccuracies, and implementing an audit solution to improve this often mundane and complex process.

When organizations fail to optimize their revenue cycle, the negative impact ripples out to the business operations of the entire organization. It creates missed opportunities to capture revenue, adds to physician burden and burnout, and hampers business performance. Providers who look to improve their financial performance and productivity need to focus and evaluate their charge capture process and ensure accuracy from when a patient’s account is created. An excellent place to start is to map out the workflow of how your charges are captured. Whether intake is in a doctor’s office, outpatient clinic, tertiary care center, or other service sites, including post-discharge.

Various Charge Capture Approaches

Charges are captured in different ways.

• According to a 2019 article in Healthcare Finance, 84% of healthcare organizations rely partly on their Electronic Health Records (EHR) systems for charge capture. Half use it exclusively as their charge capture solution, and 28% use standalone electronic solutions as part of their charge capture mix.¹ Clinical charges can be captured in an organization’s electronic health record system. EHRs can be used to perform basic charge capture; however, they often cannot capture complex charges and are not available as a go-to solution at multiple care delivery locations for physicians.

• According to the above referenced 2019 Healthcare Finance article, 27% of healthcare organizations still use a paper charge capture system.² This solution is the most cumbersome and least beneficial of all the approaches.

• Another way is through end-of-day batch processing. This approach does not impede patient care workflow, but it suffers from missed charges and lower accuracy, especially with more complex patients with multiple diagnoses and CPT codes.

• One way to reduce an organization’s missed charges and increase accuracy is to capture charges at the point of care through purpose-built third-party solutions. The room for error decreases the closer the clinician is to seeing and documenting the care for the patient. It enables the organization to capture charges immediately following care delivery regardless of location across the continuum.

Once your organization has assessed how your charges are captured and recorded, the next step is to evaluate those avenues for inaccuracies.

Reasons for Charge Capture Inaccuracies

• Decentralized charge capture responsibilities: Charge entry coordination efforts do not occur between the clinical departments, CDM teams, physicians, and other responsible staff. Clinicians are not thoroughly well-versed or abreast of the most up-to-date coding and billing guidelines. CDM teams often do not know what clinical services are provided and rely on the business owners to notify them about any discontinuance or changes in services and supplies.³ Limited information is shared between responsible departments. There is often no proper communication feedback loop regarding incomplete clinical documentation, denials, edits, payment discrepancies, and location of documents within the EHR with corresponding missing charges. 

• Gaps or glitches in technology: Be sure your software installation or conversion is appropriately managed; otherwise, it can lead to duplicate charges. In addition, the software can become corrupted by hardware errors, programming errors, or electromagnetic interference leading to a misapplication of credits. Without a good handle on these issues early on, charge capture problems can quickly compound, making it increasingly difficult to trace or correct.⁴ 

• Insufficient or incorrect coding training is more involved than simply mapping a service to a correct code. It is not always a 1:1 mapping. Some services involve multiple medical codes. 

• Human error: If the person responsible for recording charges is in the middle of a busy shift, they may enter charges that are expected but do not occur and will need to be backed out, and conversely, they may forget to add a charge resulting in an underpayment. 

• Complacent charge capture processes: It is easy to assume when a charge is entered, it is accurate when it makes its way to payment; similarly, when you fuel your car up with gas, step on the gas pedal, and expect your car to go. Unfortunately, breakdowns in the process occur, and organizations need to monitor them.

• Lack of policies and procedures: If written policies are not in place with clearly defined specific roles and responsibilities for charge capture and reconciliation, it isn’t easy to assess performance or know where or how to improve.⁵ Working with your revenue integrity team to create them will be a good start in getting your organization on track. 

Let’s Conduct an Audit

An excellent way to mitigate charge capture compliance risks is to perform an audit. Many hospitals can purchase auditing systems to catch issues with charge capture accuracy. Although they score high on speed, one drawback to these systems is that they are not foolproof. An issue may be technically correct, but it takes a human to recognize that a charge may appear valid individually but together does not work. Having the process double-checked by a trained audit professional can lead to higher accuracy rates. Higher accuracy rates lead to a shift of energy and focus to recovery and long-term health goals where providers can focus on better patient outcomes. How are you tackling your charge capture process?

Resources:

• & 2. https://www.healthcarefinancenews.com/news/most-healthcare-execs-say- charge-capture-essential-yet-40-percent-discuss-it-once-month-or-less#:~:text=Most%20organizations%2C%2084%20percent,percent%20use%20paper%20charge%20capture.
• & 5. https://www.changehealthcare.com/insights/is-charge-capture-your-revenue-cycle-weak-link
• https://www.changehealthcare.com/insights/avoid-high-cost-poor-charge-capture

Extra Resources Consulted:

• https://www.hfma.org

For more information on coding, auditing, and cancer registry, check out the MRA website here.