As we are focusing our attention to COVID, hoping better days lie ahead we must also take a look at what pandemic could mean for our business.
Although healthcare focus is on healing, they are also businesses and management must concentrate on surviving in these tough times. Auditors are the facilities first line of defense against misstated financial results. In addition to reviewing financial reports, gathering audit outcome stats, auditors must ensure that the central billing office runs effectively as possible. It is apparent that auditing must be conducted in all departments on a monthly basis to assure the organizations financial well being. Identifying potential lost revenue and charge issues before claims are submitted for improved billing compliance, and gross and net revenue capture must be an essential part of any organization.
How to improve charge capture…
One of the common causes of overlooked revenue is related with missed charges. These are charges related to supplies, devices, services, and procedures that were rendered but never billed. Missed charges may prevent the hospital from accumulating enough dollar value to hit an outlier, which also results in missed revenue opportunities.
The key to improving charge capture and reducing the revenue loss is to ensure that proper charging protocol is being followed initially. There are several ways to identify where charge capture needs to be improved.
Staff Education: Having dedicated and knowledgeable staff will go a long way toward improving charge capture, especially for clinical staff. Nurses are trained to care for patients, but no one has really taught them details about charges and why it is so important to document proper charges.
Audit Department: Creating a separate revenue and audit department staffed by an experienced nurse auditor with strong clinical and billing experience to look for charge capture issues on a daily basis. As well as meeting with department managers to determine cause for over and under charges and corrective actions that will need to be taken by the departments to rectify proper charges.
Concurrent Audits: Hospital should develop a program to perform concurrent audit (complete audit on non-disputed accounts within 30 days of patient discharge). The sample must include both inpatient and outpatient accounts.
Focus Audits: Every so often hospitals should perform audit or charge capture review on revenue generating departments. Such as pharmacy, radiology, OR, ER. Based on each hospital, departments that are going to present the greatest opportunity for missed charges are going to vary.
Charge Protocol: Maintaining and developing charge protocol and policies in all revenue producing departments in order to ensure proper implementation of all corporate charge protocols are in place and are being followed.
Charge Audit Committee: Hospital should designate a formal Chart Audit Committee attended by Chief Financial Officer, Nurse Auditor, Patient Financial Manager, Business Office Manager and Department Directors. This committee which should meet monthly to review monthly summery of the audit findings by the nurse auditor and address the trend of over and under charges and discuss corrective action that will need to be taken by department managers with excessive errors.
In the end whether the solution involves instituting new procedures, improving staff education, implementing concurrent and focus audits, the benefits are obvious. Accurate charge capture means improving cash flow which translates into increase revenue for the facility.