Charge Capture [chahrj kap-cher] noun.

A process that tends to be more irritating than a trip to Costco with your mother-in-law, the day before Christmas.

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.

Outdated methods of recording keeping, such as 3×5 inch index cards, colorful sticky notes, and paper checklists, are inefficient and cumbersome and lead to a great deal of billing blunders.

The result of these rigid old-school methods? $262 billion in lost revenue each year. That’s more than a quarter of a trillion dollars.

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, but there’s never a guarantee that the information will end up in the right place.

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

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.

File the wrong code, report an inaccurate charge description, or submit past the time limit and the claim can be delayed or denied – resulting in missed revenue, deferred payments and costly reworking.

When services go unbilled, claims are denied and reimbursements are underpaid, the financial health of a practice can be threatened.

Patient Satisfaction

Imagine the following scenario:

On Monday, Jim receives the bill for his recent colonoscopy. He is not thrilled to find that he owes $950 out of pocket, but believes it to be a fair amount for ensuring his health. On Wednesday, Jim receives a call from his doctor’s secretary saying that there was a “mix up” with the bill for his procedure, and that a new bill will be issued. On Saturday, Jim opens the new bill and sees that he now owes $2500 out of pocket. Jim is not happy at all.

Poor patient satisfaction is another inevitable consequence of a failed charge capture framework. In the customer-centric, satisfaction-driven market, many factors can negatively contribute to a consumer’s experience outside of a vendor’s control. This is no different in the healthcare industry, where the patient is the consumer and medical institutions must aim to please.

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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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.

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 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.

Products such as MediMobile, efficientC, Surgimate, and MedAptus are designed to help physicians swiftly capture charges and share information with other departments. Most importantly, they are simple to implement.

MediMobile is a customizable charge capture mobile application for physicians to document patient encounters in real time.

efficientC is a SaaS platform for revenue cycle management. Their solution helps eliminate denied claims and optimize accounts receivable.

Surgimate’s mobile application allows physicians to quickly and easily update CPT codes and surgical procedures from the OR to capture charges instantaneously.

MedAptus features an array of charge management solutions–integratable with any EHR– which deal with reconciling charges, reimbursement issues and charge capture.

There’s a profusion of these types of products popping up in the marketplace. Take advantage of the benefits they can offer.

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.