Charge Capture

Fundamentals, Challenges and

Future Planning

Lena Tisten-Richards Director-Revenue Integrity and Compliance

The views and opinions expressed in

this presentation are those of my

own and not reflective of

CHRISTUS Health.

Charge Capture-Initial State

Define Charge Capture

• What does Charge Capture mean to:

ChargeMaster

Revenue Cycle Business Office

Clinicians

Charge Capture-Initial State

Analyze Present State

Expectations • Charge Accuracy

• Charge Timeliness

• Charge Reconciliation

Policies/Procedures• Routine vs. Ancillary

• Specific Departments

Workflow • Staff/Resource limitations

• Third Party Systems

• Determine Bill Hold

What are staff being asked to do?

When were they last reviewed updated?

Are Processes standardized?

Charge Capture-Initial State

The Perfect World on Paper

• Objectives/Goals

-What do you want

DREAM BIG!

• KPI’s/Metrics

-Determine measurable outcomes

• Structure

• Communication

-Reporting

-Newsletters

Charge Capture-The Process

The process in which all charges appear on an account within

“x” days of patient discharge.

• Timeliness

-bill hold used as determinant

• Accuracy

-charge for what was performed and supplies used

• Completeness

-all charges should reflect on the account

What is Charge Capture?

3 Days

Charge Capture-The Process

What are the implications?

Charge Entry

Coding

PFS

Revenue Integrity

Clinical Areas

• Coding-backlog of accounts or

forced to hold accounts

• Clinical Areas-delays in

realizing productivity or daily

gross charges

• Revenue Integrity-pre-bill claim

checks

• PFS-reviews edits failing in claim

scrubber and submission of

corrected claims

Charge Capture-The Process

1. Charge Entry

-control departmental variances

-timing of charge execution

-third party modules

-other equipment used

2. Charge Reconciliation

-set a standard (daily)

-define responsible associate(s)

3. Post-Bill

-identify gaps and opportunities

-have a back-up plan

Fundamentals to live by……

Charge Capture 101…..

Charge Capture: Account Audits

If all else fails, what will catch what falls through the

cracks??!!

• Utilize an outside vendor to identify gaps/opportunities

Missed Charges

Over Charges

Coding Errors

• Build relationships with the vendor and utilize them as

liaisons

• Structure tools to work with your needs

-Don’t be afraid to ask for the unimaginable!

Charge Capture: Account Audits

Charge Capture Audit-The Process

• Let the charge scrubbing begin!

• All accounts analyzed for correct charges and coding

o Correct=Pass Fail=Review

• Regional Teams Review

• Revenue Integrity + Clinicians + Coding=SUCCESS

o Regional Gatekeepers

o Department Managers

o Coders

• Patient Financial Services

• Rebill corrected claims through SSI

• Corporate Team Focus and Support

• Reporting

• Process Improvement

• Monthly and Quarterly Calls

• Quarterly Newsletter

How does the Charge Audit process work?

Charge Capture Audit-The Process

1. Pinpointed specific areas and/or departments with

deficiencies

-Lack of education

-High turnover rates

-Charging module gaps

2. System Wide Opportunities

-Updated charging policy (Routine vs. Ancillary)

(example: Bedside Procedures)

3. Issues with third party vendors

-Charging/Coding in specific departments

The story behind the data….

your charge capture data

Charge Capture Audit-The Process

Each Chapter Creates Change

Get started by working through these key next steps:

1. Create a reporting package

-Distribution list

-Frequency of reporting

2. Determine focus areas

3. Metrics and KPI’s

4. Review current policies and procedures

5. Communication methods

-Q&A (charging and coding)

-Newsletters

-Scheduled Calls

6. Departmental Involvement

7. Use the data to drive upfront checks

Charge Capture Audit-The Future

• The FUTURE is NOW

-Enhanced reporting with new tools

-Utilize Charge Capture gatekeepers as educators

-Net reimbursement opportunities

-HL7 feeds for charges into Patient Accounting System

-Measurable outcomes with prompt payor payments

-Reduction in corrected claim rebills

Looking forward to the future

Charge Capture: Late Charges

VERSUS

Late Charges

Charge Capture Audit

Charge Capture: Late Charges

• Any charge entered and/or corrected greater than “x”

days post discharge:

-Documentation changes

(example: OR/Cath Lab)

-Charge corrections

-Charge Capture Audit

(post bill edits)

• Definition can vary by audience

-Patient Financial Services vs. Revenue Integrity

What is a Late Charge?

Charge Capture: Late Charges

• Failure to reconcile charges

• Incomplete/Inaccurate clinical documentation

• Process breakdowns

Departmental User Error

• Inconsistent charging practices

• Inaccurate patient data

• Third party vendor errors

• Lack of departmental education

• Lack of departmental accountability

Why do they occur?

Charge Capture: Late Charges

Don’t be afraid to air your dirty laundry

• Reporting is critical

-Metrics (average days late)

-Department 100% Late vs. Total Charges

-Rolling 6 month averages (quantity, $, etc)

-Net Late charges (remove “washes”)

Charge Capture: Late Charges

Use Your Allies or Find New Ones

CFO’s, Executives,

VP’s of Finance

Health Informatics

Departments

Schedule Meet and Greets

Ask the following questions:

1. What is their role?

2. What are they seeing?

3. When does charging occur?

4. What holds up charging?

5. Where does charging occur?

Answer the following questions:

1. What is your role

2. Why should they care

3. How can you help

4. How to support each other

5. What are your goals

D

DON’T BE AFRAID TO BE MET BY

OPPOSTION!!

Charge Capture: Late Charges

“Buy-In” is yours to achieve!

• CFO’s/VP’s Finance

-Share your goals

-Schedule regular meetings

-Review reporting and metrics

-Provide facility comparisons

-Talk about your achievements

-Ask for support

• Supply Chain

-Vendor Support

(invoicing, trunk stock, consignment)

• Health Informatics

-Systems and Functionality

Charge Capture: Late Charges

Internal Audit and Control

Audits should occur in various types:

1. Outside Vendor Support:

• ER Charging

• Supplies

• Pharmacy

• Wound Care

2. Patient Accounting System

• Admitting

• Surgery

• Therapy

• Lab

• Supplies

Charge Capture: Late Charge Reporting

Charge Capture: Late Charge Reporting

Charge Capture: Reporting

Charge Capture: Reporting

Charge Capture: Reporting

Charge Capture: Reporting

Contact Information:Lena Tistenlena.tisten@christushealth.org