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Charge Capturing

Presented By:Edvernor BurneyChart Audit ManagerEncino-Tarzana Regional Medical Center

Diana Milan, MBABusiness Manager, ED/Perioperative & Cardiology ServicesSt. Vincent Medical Center

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Charge Capturing

OverviewToolsStaffingCDMDocumentationConclusion

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- Overview

What is Charge Capturing?DefinitionCompliance

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- Tools

Facility Charging Policies and ProceduresFacility ReportsChart Audit CommitteeRevenue Cycle MeetingsWebsites (CMS, Vendor)Organizational Support

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Facility Reports

Department RevenueAPC ReportsCharge Capture Report

DailyPosted RevenueLate Charge ReportPoint of Service Report

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Chart Audit Committee

Chart Audit Committee StructureChief Financial OfficerBusiness Office ManagerMedical AuditorDepartment Directors from Nursing and other ancillary departments. Representatives from other departments (ICU, Med/Surg Nursing, Medical Records, Registration, Emergency Room, etc.) should be requested to attend as problems are identified in those areas

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Chart Audit Committee

Chart Audit Committee ResponsibilitiesAnalyze the summarized concurrent audit findings presented by the Medical Billing AuditorIdentify departments showing a trend of overcharges, undercharges, and late chargesDiscuss the possible reasons why the over and under charges are occurring; i.e., failure to properly document services, failure to process credits, failure to accurately capture charges, incomplete documentationDiscuss ideas for corrective action to be taken by the departments with excessive errors. Department managers are responsible for establishing control mechanisms to ensure timely, accurate charging and documentation of services rendered

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Hospital Revenue Cycle

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CMS Website

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– CDM

Charge Description MasterMaintenanceCoordinationErrors

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- Staffing

Chart AuditorsAPC CoordinatorsConcurrent Quality ControlDepartment ManagersCDM Coordinators

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Revenue Management DepartmentCharge Master Coordinator

Define what is chargeable - policyAuditors

InternalMedicare/MediCalCommercial

Database of Information - AnalystTrack dollars missed and how it translated into actual Net RevenueIdentify trends for re-education of staff

- Staffing

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Chart Auditor Job Description

Assists and coordinates analysis of chartsand performs focus reviews to supportPerformance Improvement and regulatory Activities of hospital. Services as a Consultant to Medical Staff Committees and Department Managers.

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Chart Auditor Job Requirements

Must be flexible to handle a variable workload, frequent work interruptions, deadlines, priority changes and multiple opinions/viewpoints.

Must be able to deal effectively with management, administration, medical staff and ancillary departments.

Participates in peer groups as necessary to keep current with Performance Improvement and regulatory standards.

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Chart Auditor Qualifications

Minimum Education: Bachelors degree in health care related field. Must have working knowledge of The Joint Commission and Department of Health Standards. Education and experience in statistical concepts, data management, variance tracking and analysis.

Required Registry or License. Professional Nursing (RN) or related health care field.

Minimum Experience: Performance Improvement experience of 3 years.

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– Documentation

Facility Policies and ProceduresClinical Quality Management

AssessmentUtilization ManagementRisk Management

Inpatient versus Outpatient

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– Documentation Continuation

MD OrdersTelephoneWritten

Nursing DocumentationChart Content

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Charge Capture Policy and Procedure

Purpose

To confirm that all patients scheduled were accounted for, procedures provided were charged and all charges entered into the department system transfer over to the billing system in a timely manner in the Surgery Information System. In order to accomplish this, a reconciliation and timely charge capture process should be performed, using the following procedures.

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Charge Capture Policy and Procedure

Policy

It is the policy to reconcile charges applied to an account and make sure that the charges are captured within 3 business days after the patient is discharged.

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Charge Capture Policy and Procedure

Procedure

Reconciliation process:Start running reportsAfter this report is reconciled then run the Access Database and run query reportsAfter validating data, save report to excel and print out “Patient Name” or “OR Time”Take document and make sure that intra-op has proper documentation of wasted items with reasons

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Charge Capture Policy and Procedure

Procedure ContinuationIf changed then reprint and send to Medical RecordsRun reportsReconcile with 3 reports:

Error ReportSurgery Interface Charge Error ListCharge Interface Report

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What do you need to get started?

● Identify key playersWho are the people posting charges in the departmentsDo they know what reports are available?Educate compliance and what is hospital policy of what is chargeableGet Managed Care Manager/Director involved

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– Conclusion

Questions?

Questions?

Questions?