Improving Charge Capture in Healthcare Facilities

Missed charges are a frequent source of overlooked revenue in healthcare facilities. These missed charges often pertain to supplies, devices, services, and procedures that have been provided to patients but were never billed. This oversight may prevent a hospital from accumulating sufficient dollar value to reach outlier thresholds, leading to missed revenue opportunities.

Strategies for Enhancing Charge Capture

The key to reducing revenue loss and improving charge capture is ensuring that proper charging protocols are followed from the outset. Several methods can help identify and address areas where charge capture requires improvement:

Staff Education

Dedicated and knowledgeable staff are crucial for improving charge capture, particularly among clinical staff. Nurses, for example, are trained to deliver patient care but may not have been taught the specifics of billing and the importance of accurate documentation of charges. Providing targeted education helps ensure staff understand their role in proper charge capture.

Audit Department

Establishing a separate revenue and audit department staffed by an experienced nurse auditor with both clinical and billing expertise can help identify charge capture issues daily. This department should meet regularly with managers to determine the causes of overcharges and undercharges and outline necessary corrective actions for each department.

Concurrent Audits

Hospitals should implement a program for concurrent audits, which involves completing an audit on non-disputed accounts within 30 days of patient discharge. These audits should include a sample of both inpatient and outpatient accounts to ensure comprehensive review.

Focus Audits

Periodic audits or charge capture reviews should be conducted in revenue-generating departments such as pharmacy, radiology, operating room, and emergency room. The departments with the greatest risk of missed charges will vary by hospital, so audits should

be tailored accordingly.

Charge Protocol

It is essential to maintain and develop charge protocols and policies in all revenue-producing departments. This ensures that all corporate charge protocols are properly implemented and followed, supporting consistent and accurate charge capture across the facility.

Charge Audit Committee

Hospitals should establish a formal Chart Audit Committee, including the Chief Financial Officer, Nurse Auditor, Patient Financial Manager, Business Office Manager, and Department Directors. This committee should meet monthly undercharges audit findings, address trends in overcharges and undercharges, and discuss the corrective actions needed for departments with excessive errors.

Conclusion

Ultimately, whether the solution involves new procedures, enhanced staff education, or the implementation of concurrent and focus audits, the benefits of accurate charge capture are clear. Improved charge capture leads to increased cash flow and greater revenue for the facility.

Julie Doumad, RN, BSN, CCFA, CMAS

Director of Audit services 

American Healthcare Audit Professionals Inc.