Charge Capture and Revenue Integrity

Charge capture is a crucial part of the revenue cycle process. Accurate charge capture processes will improve cash flow and increase revenue which will improve the bottom line and satisfy regulatory compliance. Healthcare organizations that fail to accurately document information on the care provided at their facilities can potentially lose millions in revenue.

Healthcare organizations need to focus on charge capture and charge audit. Although some healthcare organizations have a dedicated department focused on preserving revenue integrity, many healthcare organizations address the concept less formally. A strong clinical chart auditing program will ensure sound documentation, improving healthcare organizations ability to capture missed revenue, reduce denials and improve patient care.

Chart auditing is an extremely important part of charge capture and conducting a monthly Concurrent Audit Review should be part of every healthcare organization.  A concurrent audit is defined as a complete audit on a non-disputed account on both inpatient and outpatient accounts to verify that charges represent services rendered to the patient are accurate and are ordered by physician as well as identifying and correcting any discrepancies.

A proper trained Medical Chart Auditor with strong clinical and billing experience assisting the appropriate department managers and nursing departments with maintaining and/or developing Charging Protocols and Policies in all revenue producing departments can play a significant role in identifying, correcting and improving the recovery of lost revenue process within your healthcare facility/organization.

Organizations that are not consistently working to improve charge capture, denials, and underpayments, are leaving money on the table which can add up to tens of millions of dollars as well as to compliance problems and external payer audits.

Benefit of external partner

At times, it can be overwhelming to identify the proper audit channels, and a third-party resource can be quite valuable. Within a revenue integrity department, there are so many objectives to focus on and at times, it is easy to spread yourself thin. A third party can bring a fresh perspective, which is a non-biased outlook to charge capture function. Facilities that choose to outsource due to the shortage of qualified nurse auditors and qualified medical coders find that they gain more control of their revenue cycle, with an added benefit of increased revenue collection. Outsourcing is a solution that fits the needs of large hospital groups, standalone hospitals, large and small physician groups, and other healthcare organizations. It can result in reduced backlogs and reduced cost.

In conclusion, regardless of each organizational approach, revenue recovery and charge capture can make a substantial and significant impact to the facilities bottom-line. Every revenue generating department within the hospital must properly document and record charges in order to establish control mechanisms to ensure that appropriate procedures and charging protocol are being followed thereby maintaining a healthy economic environment.