It is becoming more difficult than ever for medical practices to maintain — let alone increase — revenue and profits. Revenue cycle management has become increasingly complicated over the years with the advancement in EHR technology and value based reimbursement on the up and up. With so many changes taking place with healthcare reimbursement and challenges in getting paid, practices can't afford to ignore the charge capture process.
Practices can increase revenue and profitability by increasing patient volumes seen in a day or they can ensure there is no revenue leakage for some of the services provided. Practices need to make sure there are no overlooked un-billed encounters or missing charges.
This is why setting in place the necessary and appropriate charge capture processes and procedures is so important. Medicare fee schedules have decreased while practice expenses have increased. Therefore, if you are going to invest in EHRs, make sure there is mobile charge capture functionality and also train physicians to use electronic charge capture.
Failures in charge capture can be considered to be like throwing money down the drain. And this is money that is far from chump change.
Consider an individual provider who might be on call for a hospital for four hours every Monday of the week. He’ll be on call for a total of either 16 or 20 hours every month. Let us say he performs 40 consultations in that time in a month and is reimbursed at $100 per consultation. If there’s leakage (because of failure in charge capture) of 20 percent, that’ll cost him $800 per month and $9,600 per year.
Since provider salaries are often productivity-linked these days, once they become conscious of how much they stand to lose, they’ll be sure to ensure all the charges are captured. With the latest technologies such as smartphones, tablets/iPads, and the EHR software in place, physicians can be trained to use mobile devices to schedule inpatient consults or to communicate the details of such visits to the EHR system.
For hospitals, these losses can quickly add up. It’s common for even small hospitals to gain half a million dollars in additional revenue just with improved charge capture processes. Of course, larger hospital systems will easily earn millions of dollars in additional revenue with improved charge capture processes in place. Any investments in hardware — such as equipping everyone with iPads from which to log in to the EHR — will easily pay off in a matter of years, if not months.
Having the right systems in place will ensure that no patient encounters slip through the cracks. First of all, all patient visits must be scheduled — say in a scheduling software or a practice management system (PMS) software. Reconciling schedules with the reports generated by the PMS software will locate any un-billed charges. This will help with the charge capture related to inpatient consults or nursing home visits which can be overlooked in the scheduling process.
Going for electronic means or ‘mobile charge capture’ also enlarges the range of CPT codes the provider can access through software instead of being limited to the few options that can be printed on a piece of paper; hence, the coding can be better and possibly more accurate.
A charge-capture audit is the next step to make sure the systems in place are working and being utilized. Charge-capture audits can be as simple or as detailed as desired. You can audit a week’s worth of schedules or for some random days.
With ICD-10, CPT/HCPCS codes as well as various rules regarding their use (e.g. NCCI coding edits, NCDs, LCDs) that pertain to geography, payer type, and provider specialty, it’s easy to submit a bill that gets something wrong and the payer will then deny the claim. It’s better to get things right the first time rather than having to correct the error and resubmit the claim.
Effective charge capture, along with the other associate steps, will help practices increase profitability.