Companies typically audit charge capture to find and fix these issues. When appropriately done, Audits of charge capture can significantly improve the collection of lost revenue, ensure compliance, and enhance general financial efficiency.
What is charge capture? And the importance of it?
Recording charges involves recording, posting, and reconciling charges related to medical treatments provided in a consultation with a patient. This covers therapies, laboratory tests, and diagnostic services. Pharmacy and other aspects related to patient care, like diagnoses and procedures.
The charging capture procedure is carried out in the financial and clinical systems. Data input is made through multiple systems derived from various capacities.
Charges are a crucial element to ensure accurate coding since they represent the services provided and support the usage of particular revenue codes, such as DRGs (diagnosis-related groups) and HCCs (hierarchical category of conditions) and drive the charges. The correct charge codes help to ensure that the code is accurate and improve the likelihood of prompt payments.
From a billing point of view, Payers will typically scrutinise charges from various perspectives, so the providers have to ensure that all charges are accurately recorded and backed by appropriate documents and revenue codes and that they meet the specific requirements of payers, like medical necessity or pre-authorization.
What can we expect from an audit of charge capture?
After completion, a charge review should give actionable insight into these areas:
- Understand the current status of the charge capture process at the department level, which includes the methods, systems, and staff involved.
- A brief understanding of charges capture issues, which could include the failure to report charges, posting charges post billing cycles, charging for in error service(s) and billing the wrong patient, or with multiple accounts, a services not being listed on the bill sheet/charge screen, or inability to reconcile charges or examine error report.
- An overview of the interdependencies that can lead to incorrect charges, for example, the role of one department’s position on its performance in the future.
Who is responsible for setting up an auditing process for charge capture?
Due to the specific character of how charges are entered into the system in charge capture audits, the team that oversees your charge capture audit needs to be comprised of members from your finance, IT, and clinical teams.
A Revenue Integrity team member should lead a charge capture audit in the ideal scenario. The audit will offer valuable, practical insights into the present situation from both a user’s and a system’s perspective. Additionally, it will aid in identifying the root cause, determining remedial steps, and implementing the required enhancements.
Concluion
After completing a charge capture audit, the team must examine their findings against industry standards for accurate charge capture. This will establish a context of how common specific concerns could be and where to concentrate your efforts. Following this, you can prioritise issues you want to address, identify the cause, take corrective measures regarding the initial charge capture process, and monitor the controls.
