Mastering the Charge Capture Process by Enhancing Revenue Cycle Efficiency

Charge capture is a critical process in healthcare that ensures medical practices receive proper reimbursement for the services they provide. In a recent study, experts found that the average medical practice loses $125,000 annually due to gaps in charge capture processes. To remain financially viable and receive reasonable compensation for services rendered, healthcare providers must make their charge capture processes a priority.

 

What is Charge Capture in Healthcare?

Charge capture refers to the process of accurately recording and billing for all services rendered to patients. It encompasses the following steps:

1. Services rendered to the patient

This involves documenting all services provided to the patient during their visit or stay, including procedures, tests, treatments, and consultations.

2. Documentation of the services provided

Accurate and comprehensive documentation of the services rendered is crucial. This typically involves recording details in the patient’s electronic health record (EHR) or medical chart, including diagnosis codes, procedure codes, and other relevant information.

3. Coding the services using appropriate medical codes

The documented services must be translated into appropriate medical codes, such as CPT (Current Procedural Terminology) codes for procedures and ICD (International Classification of Diseases) codes for diagnoses. Proper coding ensures accurate billing and reimbursement.

4. Creating and submitting charge entries to the payer

Based on the coded services, charge entries are created and submitted to the payer (insurance company or government program) for reimbursement. This step involves verifying patient information, documenting insurance details, and ensuring all charges are accurately captured and submitted.

5. Receiving reimbursement for the submitted charges

Once the charges are submitted, the payer processes the claim and remits payment to the healthcare provider for the covered services. If a claim is denied, providers should promptly follow up and resubmit when necessary.

Proper charge capture ensures that healthcare providers are compensated for the work they perform, enabling them to maintain operations and provide quality care—but it’s a lot to manage! Cross-departmental collaboration from care providers to front-office staff is crucial to ensure nothing gets missed. Intelligent EHR and PM software can help provide seamless knowledge transfer, from initially capturing information in the room with patients, all the way through to submitting claims for reimbursement.

Charge Capture Challenges

Even though practices may have solid revenue cycle management practices in place, errors throughout the charge capture process can occur frequently. Some common challenges include:

Documentation errors:

Multiple departments and roles are involved throughout the charge capture cycle, increasing the potential for mistakes. Without proper communication, information can easily be misplaced or misinterpreted.

Time constraints:

For small practices especially, providers are often responsible for managing their own billing which takes up a considerable amount of time.

Lack of standardization:

Inconsistent processes can lead to bottlenecks and inefficiencies.

Staff knowledge gaps:

Employees may struggle to facilitate efficient charge capture due to a lack of training or experience. Independent practices usually have front-office staff, but they often do not come from a background of medical billing. Without the right training, errors can be made.

Regulatory changes:

On a similar note, keeping up with evolving rules and policies from payers and regulatory bodies can be challenging—regulations tend to change annually. Even one number’s difference in a frequently used code can create significant friction when new guidelines are rolled out.

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Charge Capture Best Practices

To overcome these challenges and receive the most compensation possible, healthcare organizations should ensure they’re regularly examining what’s working and what could be improved. Below, we’ll explore some of the tactics that practices can employ to reduce friction and allow for more effective charge capture.

Invest in Ongoing Training

Emphasize the importance of charge capture and align departments through regular training sessions. Whether you hold training in-house or enroll your team in ongoing education, staying abreast of industry trends and changes allows your practice to be proactive versus reactive.

Document Processes

If you have a set of systems and processes that support your practice with charge capture, document those workflows. This will allow for more seamless onboarding with new team members, and the more consistent you are, the lower your chance of missteps.

Use Efficient Software

Utilize robust electronic health record (EHR) and billing software to streamline charge capture processes. The right software will be fitted with workflows and automations that can save your team precious time and reduce the likelihood of errors associated with manual data entry.

Conduct Regular Audits

If you aren’t already, you should regularly pull reports that demonstrate how your practice is performing. Monitor claim denial rates, average time to reimbursement, and other relevant metrics to identify areas for improvement. Sometimes, practices find it beneficial to hire a company to perform an audit independently, but starting in-house is a great way to glean more insights into what’s working and what isn’t.

Submit Claims Promptly

Adhere to schedules for submitting and resubmitting claims to ensure prompt reimbursement. When time passes between patient encounters and charge submissions, things can slip through the cracks. If possible, aim to submit claims at the end of each business day.

Improve Your Charge Capture Processes with Benchmark Solutions

Benchmark Solutions understands the complexities of charge capture and can assist practices in all their RCM processes. Our team of experts can provide guidance, training, and support to ensure accurate and timely charge capture, ultimately improving your practice’s financial health. Whether you’d prefer to outsource everything entirely, or you’d rather bring our experts on to provide support where needed, we’d be happy to help where we can. Contact us today to learn more about our revenue cycle management services and supporting software systems.

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