Charge capture is a fundamental revenue cycle element. It is the source of both hospital and doctor reimbursement. In theory, it is easy to note every service provided to secure payment, but charge capture can be a hassle in practice.
It is a complex field that has a lot of potential for mistakes. It usually involves data that comes from a variety of sources and dissimilar methods that require manual intervention to collect the data, reconcile and compile. Additionally, healthcare providers must contend with ever-changing rules and regulations for payers, which result in significant leakage of revenue – as high as 1 per cent of the net revenue from patients in the estimation of the Healthcare Financial Management Association.
To ensure accurate billing and prevent revenue loss, healthcare organizations must implement charge capture best practices that streamline documentation and coding processes. By leveraging automation, real-time data entry, and regular audits, providers can reduce errors, improve compliance, and enhance financial performance.
How does charge capture get done?
At the simplest level, charge capture involves the healthcare professional who provides the service and records it to be billed. Some physician practices and hospitals continue to record charges on paper at the time of service.
However, with electronic health record systems becoming common in hospitals, most healthcare facilities utilize EHR technology and digital devices to capture primary charges in all healthcare environments. Between paper and EHR are third-party programs and services that could be used for primary or ancillary charge capture functions, such as managing all charges incurred by the physician or hospital’s billing system or aiding in identifying missing charges that aren’t documented on the EHR.
The point at which the system is broken
The most widely used healthcare IT system managing charge capture is EHR. In the past few years, most healthcare facilities have relied, at a minimum, upon their EHR systems to capture charge, with the majority of them employing it completely. However, making use of your EHR as your only (or primary) charge-capturing system can cause several challenges:
Health services are offered throughout a continuum of health care across a range of locations and settings. Each facility has to be equipped and prepared to ensure full recording of all eligible charges
Continuously changing reimbursement requirements in the myriad of commercial payer contracts, each with its own distinct requirements, rates and timing considerations, could often result in missed charges or overcharges
Incompatible administrative and clinical systems frequently miss code edits or billing changes, resulting in inaccurate billing statements that could result in claim denials as well as issues with compliance
Poor medical coding procedures and policies in the system that require expert expertise in the thousands of CPT and HCPCS codes, as well as their exact implementation, are the recipe for a higher risk of revenue leakage
Human error could introduce incorrect charge information into a medical record by introducing incorrect transcription and data entry at the time of care or the transfer of errors while moving information between systems. the next
