Strategies to Improve Charge Capture

Understanding Missed Charges and Their Impact

One of the frequent contributors to lost revenue in hospitals is the oversight of charges. Charges for supplies, devices, services, and procedures that are provided but not billed often go unnoticed. When these charges are missed, hospitals may fail to reach the required dollar amounts for outlier payments, ultimately losing valuable revenue opportunities.

Establishing Proper Charging Protocols

The main strategy for enhancing charge capture and minimizing revenue loss lies in ensuring that correct charging protocols are followed from the outset. Identifying the areas where charge capture needs improvement is critical, and there are several approaches hospitals can take to address this issue.

Staff Education

Staff Education: Having dedicated and knowledgeable staff is essential for improving charge capture, particularly among clinical personnel. While nurses are expertly trained in patient care, they often lack instruction on the specifics of charge documentation and the importance of accurate billing. Providing targeted education helps bridge this gap and empowers staff to contribute effectively to charging capture efforts.

Audit Department

Audit Department: Hospitals can benefit from establishing a separate revenue and audit department. This department should be staffed by an experienced nurse auditor who possesses both clinical and billing expertise. The auditor’s responsibilities include identifying charge capture issues daily and collaborating with department managers to investigate causes of overcharges and undercharges. Together, they can determine corrective actions to ensure proper charge documentation moving forward.

Concurrent Audits

Concurrent Audits: Implementing a program for concurrent audits is another effective solution. Hospitals should perform complete audits on non-disputed accounts within 30 days of patient discharge. The audit samples must encompass both inpatient and outpatient accounts to provide a comprehensive view of potential charge capture gaps.

Focus Audits

Focus Audits: Periodically, hospitals should conduct audits or charge capture reviews specifically targeting revenue-generating departments such as pharmacy, radiology, operating room (OR), and emergency room (ER). The departments with the greatest risk for missed charges will vary by institution, so each hospital should tailor its focus audits to address its unique opportunities for improvement.

Charge Protocols and Policies

Charge Protocol: Hospitals must continuously develop and maintain charge protocols and policies within all revenue-producing departments. Ensuring that corporate charge protocols are implemented and consistently followed across departments is vital for accurate charge capture.

Charge Audit Committee

Charge Audit Committee: Forming a formal Chart Audit Committee is a key organizational step. This committee should include the Chief Financial Officer, Nurse Auditor, Patient Financial Manager, Business Office Manager, and Department Directors. Meeting monthly, the committee reviews audit summaries, analyzes trends in overcharges and undercharges, and discusses corrective actions needed for departments with excessive errors. This collaborative approach drives accountability and improvement throughout the hospital.

Benefits of Accurate Charge Capture

Whether the solution involves new procedures, enhanced staff education, or systematic concurrent and focus audits, the advantages of accurate charge capture are evident. When hospitals capture charges accurately, they improve their cash flow and increase revenue, resulting in financial benefits for the entire facility.

Julie Doumad, RN, BSN, CMAS, CCFA

Director of Audit Services

(American Healthcare Audit Professionals, Inc.)