Improve Revenue Integrity & Maximize Reimbursement Through Effective Charge Capture
With the continued rising pressures for Healthcare Leaders related to higher costs, lower reimbursement, and more stringent regulations, they are faced with goals of maximizing reimbursement, minimizing revenue leakage, preventing denials, and expediting claims submission. In order to achieve these goals, we recommend implementing a Charge Master Management Solution, Charge Capture/Charge Reconciliation Process, and Claim Form Optimization/Maintenance Plan. These are three of the key components of revenue integrity, that when mismanaged, can poorly impact an organization’s financial health.
In this multi-part series, we will continue to look at breaking down each of these key components: (1) What every organization should ask and understand; (2) Defining the workflow starting with optimization through maintenance; and (3) Benefits of adopting an optimal best practice. Charge Capture/Charge Reconciliation is a critical component to improving revenue integrity. These three components make up a portion of the Patient Centric Enterprise Revenue Cycle model that is highly effective in healthcare.
If you missed part one of the series, please read, “How to Organize Your Organization’s CDM.”
What Every Organization Should Ask & Understand
The Patient Centric Enterprise Revenue Cycle is a sequence of workflows, data flow, and events across the entire health system that align to generate income, improve profitability, decrease denials, increase excellence in customer service, and lower costs. In the end, nearly every individual across the continuum of care has a critical role to play in a fully integrated Patient Centric Enterprise Revenue Cycle. In order to prevent revenue leakage and maximize reimbursement, a cohesive process of monitoring and oversight needs to be adopted and not become the sole responsibility of the Patient Financial Services Leaders. An organization should understand that this monitoring and oversight needs to be highly connected to various other departments within the healthcare organization along with Patient Financial Services.
Issues/Revenue Leakage Identified in Recent Revenue Cycle Assessments
- Paper Driven: Charging practices in various areas of organizations still reside on paper and manual batch entry
- Documentation Driven Charges: Not always aligned with Patient Financial Services and in some cases tend to be electronic super bills or checklist
- Bill Days: Increased days it takes for a claim to be billed related to billers tracking down missing charges, modifiers, CPT/HCPCs codes, and missing data
- Late Charges: Increased late charges due to manual processes, rejections not being worked and charging practices (charge on result for procedures that can be charged on order)
- Payer Audits: Increased audits, takebacks or denials related to charges/services not supported by documentation
- Missing Charges: Identified missing charges due to lack of understanding of chargeable items/services, higher charge rejections not being addressed ties, or charge driven documentation not linked to billing
Is Your Organization…
- Utilizing the right resources to address Charge Capture/Charge Reconciliation?
- Maximizing reimbursement?
- Experiencing higher volumes of late charges?
- Experiencing charge leakage?
- Experiencing increased denials?
- Planning to standardize, consolidate, or migrate to a new system; incorporating Ambulatory/Clinics with Acute Services?
If the answer to any of the above questions is “yes,” keep reading for information to help achieve improved Revenue Integrity and Patient Centric Enterprise Revenue Cycle Model through implementing a Charge Capture/Charge Reconciliation Team.
Defining the Workflow (Optimization to Maintenance)
An organization should understand the importance of adopting a Charge Capture/Charge Reconciliation Team to govern Charge Capture improvements, Charge Reconciliation processes, and Charge Rejection remediation. This team should be the foundation of the charge capture and charge reconciliation process to ensure there is accountability to resolving outstanding issues between the departments and patient financial services, identify areas of improvement through charge based documentation, and strive for charge standardization through future optimizations.
Steps to the solution
- Understand your organization current and future vision: i.e. service lines offered; growth opportunities; current metrics and baselines; and ambulatory/acute enterprise model
- Define organizational goals: i.e. metrics-driven results, charge capture improvements, defined charge reconciliation process, increased gross revenue results, and adhere to compliance
- Develop team structure: ensure accountability; positive results; effectiveness to enforce change; and collaborative efforts between charging departments, patient accounting, and leadership
- Designate key individuals to monitor and correct charge rejections timely
- Ensure the ongoing integrity of the Charge Capture/Charge Reconciliation team through shared ownership of the organization’s success
Why Implement the structure/benefits realized
Organizations that design a structure of shared ownership of the Charge Capture/Charge Reconciliation process have reported immediate benefits with long-term success. The focus on improving the Revenue Integrity is key for organizations with visions of adopting an Enterprise Revenue Cycle model; optimizing current multi-facility solutions including combined Ambulatory/Acute facilities using the same EHR; or improving processes in a single standalone facility.
Designate a Charge Reconciliation/Charge Capture Team – Why
- Shared ownership of the revenue cycle strengthens the organization and maximizes reimbursement
- Continuous monitoring reduces late charges, minimizes revenue leakage and decreases denied claims
- Positions the organization for continuous improvement and reduces paper/manual batch entry
- Improves Clinician’s experience seamless integration of charge based documentation
- Have the information and metrics necessary to understand the clinical impact to Patient Centric Revenue Cycle Management
The second step in improving an organization’s revenue integrity, after optimizing the CDM (1st Key Component) is to establish a Charge Capture/Charge Reconciliation team. This team becomes the foundation of improving Revenue Integrity and will ensure that there is accountability for resolving outstanding issues between Departments and Patient Accounting; defining preventative solutions; and identifying future improvements. Taking steps to understand, appoint and implement a designated team with leadership oversight will help position your organization to prevent leakage, improve reimbursement, ensure compliance and give and organization continuous improvement advantage.
Contact Jacobus to ask about our approach to designing, implementing and sustaining a Charge Capture/Charge Reconciliation team; and defining the right resources to ensure success. Also, watch for part 3 of the series on Improving Revenue Integrity and Maximizing Reimbursement, which will review the Claims Form Optimization/Maintenance Solutions.