Avoid Pitfalls that Limit Charge Capture

Andrew McDevitt

Robust charge capture helps ensure that patients and insurers are correctly and completely charged for all services rendered.  Is your system leaking money? Watch for these red flags: neglected error logs, black holes and out-of-sync systems.

Actively work your error logs and edit reports

Your error logs and edit reports hold many clues to charge capture breakdowns. Monitor them and you might learn:

  • Data is being incorrectly scrubbed as it crosses from one system to another.
  • A particular department needs training on new codes, since you’re seeing a spike in their edits and errors.

Plug black holes

When you set up your charge editing system, make sure every charge and edit has a landing spot. Run a regular review of work file distribution to validate all your charge scenarios.

If it’s been a while since you set up your system, make sure your model still works for new providers and locations. Check that work queues can handle variations in provider schedule or location.

One company I worked with had $5+ million in charges slipping through the cracks because of black holes in user and staff assignments.

Keep systems in sync

Charging and billing systems that are out of sync are another pitfall—especially when codes change. If your handheld charging system is updated but the billing system lacks the new codes, charges might be edited out. Again, money lost.

In addition, interface logic could be adjusting codes.  Very often there were valid reasons for these adjustments when you set up the logic. But systems and requirements change. A thorough review can identify opportunities to capture those charges.

Want to know more? See my earlier post on helping clinicians provide information you need.

 


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