Is Surgical Charge Capture Throwing a Curve at Your Bottom Line?

Charge Capture [chahrj kap-cher] noun.

A process that tends to be more irritating than discovering your grill has no gas on July 4^th

The Stakes

When physicians are not in the exam room or the OR, they are documenting patient encounters and filling out heaps of paperwork. This step is one of many, in the process referred to as charge capture — where physicians, clinicians, and billers amass the torrent of information necessary to file a medical claim for a surgery.

Outdated methods of record keeping, such as 3×5 inch index cards, colorful sticky notes, and paper checklists, are not only inefficient and cumbersome, they are not HIPAA compliant and lead to a great deal of billing blunders.

The result of these rigid old-school methods? $262 billion in lost revenue each year. And the larger the practice, the greater the potential loss. If a few codes slip through the cracks in a small practice, it’s problematic and frustrating. If this happens repeatedly at a large practice, it can be crippling.

Adding technology to the system is helpful since automating processes can drastically curtail errors, and strengthen the quality of submitted claims. But, incorporating more systems to automate the claims and billing process is only part of the equation. Many EHR systems offer plug-ins or add-on tools to assist with billing and coding for clinical visits, but capturing surgical charges is more complex and not supported. 

The answer to such medical claim debacles? Introduce a prescribed, tech-driven workflow that makes it clear to every department and individual involved exactly what they need to do at each stage in the process.

The Impact

Reimbursement

File a surgical code not authorized by insurance, report an inaccurate charge description, skip a modifier, or submit past the time limit and the claim can be delayed or denied – resulting in missed revenue, deferred payments and costly reworking. Whether it’s regular charges, add-on codes, or consults, when services go unbilled, claims are denied and reimbursements are underpaid, the financial health of a practice can be threatened.

According to the American Academy of Family Physicians, the medical claim denial rate is 5-10%.  For many surgical practices, receiving a claim denial is a regular occurrence. While 90% of denials are avoidable, only 66% are recoverable. Denied claims cost, on average, $118 per claim to recover the money lost. Across the United States, $9 billion is spent alone on the administrative costs associated with recovering the lost revenue from denied claims.

Reconciliation

Even if billing staff receive notification (whether it be on paper or electronically) of charges that need to captured, ensuring these charges are actually processed is another step that often happens manually. Staff either go into the appointment scheduler and manually mark off the surgeries that the MDs have submitted for, or keep a paper list that they literally check off with a pen. With each item checked off valued in the thousands of dollars, this method seems more rudimentary than remunerating.

Regulatory Compliance

HIPAA is not the only compliance framework medical practices must worry about. There is also the False Claims Act, the Clinical Laboratory Improvement Amendments, the Stark Law and others. Overseeing everything is The Office of Inspector General (OIG), which has strict rules for how medical institutions must comply with such policies.

Medical billing compliance is designed to prevent fraud. And just like fraud in any industry, this crime can carry a hefty fine.

The OIG and Department of Health will audit any practice they suspect of upcoding –adding extra tests or procedures– or downcoding — intentionally leave out tests or procedures.

Internal audits should be included in a charge capture workflow to ensure compliance and prevent costly errors.

The Solution

Standardize Operational Procedures and Policies

The first step to improving the charge capture process is to institute a prescribed workflow, starting from the time the patient arrives until the medical claim is submitted. Every department should be involved – from surgeons, to schedulers to billers. Protocol should be well documented, and employees should be well trained regarding their individual tasks and the bigger picture.

Internal Auditing

With the hectic nature of a medical practice, it’s no surprise that items on paperwork can get checked off incorrectly, charges reported twice by different staff members, and old prescriptions find their way onto new bills. To avoid such mistakes and improve billing accuracy, practices should build quality assurance checks into their workflow. Adding a system of periodic internal auditing for departments and staff involved in charge capture will reduce the likelihood of errors and punitive fines

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Leverage IT

Adopting an EHR system can improve charge capture by an average of $11.49 additional collect charges per patient. For the average-sized medical practice, this translates to thousands of dollars in extra revenue per month. However, many EHR systems do not have portals specifically designed to automate the surgical capture process and collaborate with other departments.

Introducing new technology or plug-ins, which integrate with your practice’s existing EHR, is worth the investment.

Surgimate’s mobile application allows surgeons to quickly and easily capture their surgical charges from any mobile device. This includes:

• Confirm authorized CPT codes actually performed.
• Add additional CPT codes not authorized (to alert billing/precert to retro-authorize). When this is completed in a timely manner, retro-authorization won’t be necessary and it eliminates the chance of denial.
• Confirm and adjust billing modifiers as necessary.
• Capture consults & on-calls to ensure they are billed.

The data can automatically be synced with your billing system to ensure all codes are accounted for and billed.

The Surgimate App

Augusta Orthopedic & Sports Medicine Specialists, PC

The Payoff

Streamlining charge capture processes enable a practice to enhance profitability and communication across departments. Creating standard procedures, and conducting internal audits will ensure a decline in claim denials, fewer compliance issues, and improved patient satisfaction. No less importantly, it will save your medical practice thousands of dollars a year.

“I use the Surgimate App to send post-op notes and add-on codes right after surgery. This way, the billing department can begin the claims process immediately, reducing denials.”   Dr. Richard Pope, MD | Orthopedic Surgeon Augusta Orthopedic & Sports Medicine Specialists, PC See full case study