Build bridges to solve charge capture and reconciliation issues before they hit denials

Accurate charge capture is the foundation of revenue integrity. Sophisticated tools allow revenue integrity staff to sift through data, track trends, and pinpoint missing or inaccurate charges. But a revenue integrity department that simply focuses on identifying and addressing charge capture failures on the back end will find themselves trapped in a Sisyphean cycle. Instead, apply lessons learned from data analytics and back-end processes to help clinical staff capture the correct charges from the start.

When Barbara Fisher, CHC, corporate director of revenue integrity and denials management of the revenue integrity department at Shiners Hospitals for Children in Tampa, Florida, first took on the role with Shriners, she worked hard to reinforce the importance of daily charge capture reconciliation. This was new territory to many of the system’s staff. For most of its 100 years, the 20-hospital health system lived entirely off its endowment and did not submit claims to payers. In 2010, the system decided to supplement its endowment and implemented a systemwide revenue cycle.

Clinical staff were initially wary that revenue cycle activities, such as daily charge capture reconciliation, would take away from the time they spent providing patient care. Fisher was quick to reassure them that far from minimizing patient care it would ultimately ensure better care and support for the patients and their families.

“When you have a system like ours where they work so hard, they give such great care for the kids, that if they have to take their eyes off taking care of the kids to do something that’s not, in their opinion, hands-on care, you have to make sure they understand why you’re doing it,” Fisher says.

Fisher used two points to put charge capture reconciliation in perspective for clinical staff. First, it ensures the system is following regulations. Take the time to explain how the regulations work and set up one-on-one discussions with clinical leaders, she recommends. Often, charges are missing or not supported by documentation because clinical staff aren’t aware that they’re making a mistake.

Fisher’s second point helps assure clinical staff that revenue integrity and clinical departments are working toward the same goal. Accurate charge capture and reconciliation reduce revenue leakage and will help sustain the system’s mission for years to come, she says. “Sometimes you have to tell them, ‘Our priority is to take care of the patient and we are with you on that. However, we want to sustain the mission. Can you help us that we can get this accomplished together?’.”

Although billing and charging regulations might be second nature to revenue integrity staff, clinical staff often need a little help navigating the rules. Fisher’s department hosts monthly charge capture calls during which they highlight issues they’ve uncovered during internal audits as well as concerns that revenue cycle managers bring to them. If recent audits have discovered a trend in missing charges or documentation for observation services, Fisher and her team will walk through the applicable regulations and what action clinical staff should take.

Fisher notes that at Shriners all observation charges are on a 100% bill hold. The revenue integrity team reviews a daily report for the previous day’s observation charges. “If they find discrepancies, they query the applicable hospital. Once corrections are made the charges are cleared for submission,” she says. “We also trend issues to provide education as needed.”

It also behooves revenue integrity to make charge capture as easy as possible. Nurses are extremely busy and are responsible for caring for many patients—it’s often difficult for them to see how they can fit in extra time at the end of their shifts for charge capture reconciliation, Fisher notes. “We’ll sit down with them and we’ll show them how they can do that,” she says.

Look at how forms are designed and how information is entered in the EHR. Staff might miss critical fields or not understand exactly what information should be entered where. Work with clinical leaders to learn what they need and then tailor forms and data entry to optimize ease of use and documentation. In some cases, it can be helpful to add tips for clinicians on forms, Fisher says.

Even the most highly sophisticated revenue integrity department will have its hands tied if it fails to foster a collaborative relationship with other key departments. By providing clinical staff with the tools and knowledge to ensure accurate charge capture and reconciliation, revenue integrity will set both teams up for success.