Recover Missing Revenue: Optimize Your Clinical Charge Capture

Missing revenue? It might be hiding in your charge capture process!

One of the most effective ways to recover missing revenue is by optimizing clinical charge capture. Hospitals and healthcare systems can enhance their financial performance by reviewing and refining their charge capture processes, which involves auditing and ensuring that procedures, medications, and services are accurately billed and coded.

What is Clinical Charge Capture?

Charge capture refers to the process of recording and submitting the charges associated with healthcare services provided to patients. Inaccuracies in this process can result in significant revenue losses due to under-billing or delayed claims. This can occur when the charges associated with certain services are missed, or if incorrect codes are used for billing.

Optimizing charge capture can improve revenue cycle efficiency, reduce denials, and ensure that healthcare providers receive accurate reimbursement for the services they provide. By conducting detailed audits and refining the charge capture process, healthcare organizations can uncover areas of lost revenue and prevent further losses.

Key Steps in Charge Capture Optimization

 

1. Data Extraction and Review

The first step in optimizing charge capture involves extracting data from the hospital’s financial and clinical systems, such as the chargemaster and formulary files. This data is then reviewed to identify potential errors, such as incorrect or missing charges, incorrect billing codes, and inconsistencies in unit pricing.

For example, medications with a price of $0 or below the minimum drug price can flag areas where revenue is being missed. Similarly, charge codes that don’t align with the clinical service or medication dispensed must be corrected to avoid claim rejections.

2. Audit and Analysis

Auditing involves a deep dive into specific service areas, such as pharmacy, surgical, or emergency services. Each area is analyzed to ensure that all billable services and items are correctly documented and assigned the appropriate charge codes.

For instance, reviewing procedures like IV infusions or surgical supplies helps to identify whether all necessary charges have been captured. Similarly, auditing anesthesia procedures or recovery charges ensures that every aspect of care is billed correctly, capturing all revenue opportunities.

3. Issue Conversion and Billing Units

Optimizing charge capture also involves ensuring that the issue conversion factor (how the clinician orders medication or services) matches the billing conversion factor (how the service is billed). Misalignments between these two factors can lead to revenue losses or claim denials.

For example, medications administered in doses must have the correct billing conversion factor. If the billing units don’t match the dosage ordered by the clinician, claims can be denied, resulting in lost revenue.

4. Continuous Monitoring and Updates

Charge capture optimization is not a one-time process. Regular audits and updates are necessary to keep up with regulatory changes, new medications, and service offerings. Hospitals should continuously monitor their chargemaster, formulary files, and clinical documentation processes to ensure ongoing accuracy.

Working with a Partner

Optimizing clinical charge capture is essential for recovering missing revenue and ensuring financial health in healthcare organizations. By working with a partner who can help with data extraction, auditing, and refining billing processes, hospitals can improve revenue cycle efficiency, reduce claim denials, and ensure accurate reimbursement for services provided.

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