Five steps for facilitating charge capture accuracy

The methods for maximizing revenue capture have changed over the years. Revenue management has evolved from random chart audits to using data analytics and technology to find patterns. Tina Rosier, director of revenue integrity at Community Health Network in Indianapolis, shares how implementing predictive analytics has helped her team facilitate charge capture accuracy.

“In 2005, we did random chart audits, which was like looking for a needle in a haystack. Now we’ve leveraged our technology to help us find missing charges,” she says. For Rosier, that meant using EPIC and Revenue Guardian checks to find accounts with inaccurate charges. For example, a work queue in EPIC might flag a procedure that includes a 390 blood product charge but lacks a 391 blood administration charge. Rosier’s team would then review this account and add the missing charge.

The revenue integrity team at Community Health Network wasn’t always as established as it is today. In fact, the team began in 2005 with only Rosier, and has developed into a team of nine revenue integrity analysts and 14 charge capture staff members over the years. Today, Rosier’s team reviews charts, captures the charges for all nursing units and several departments, completes process improvement initiatives, and reviews hundreds of accounts weekly for inaccurate charges and/or claim errors. By working together with the clinicians, coders, chargemaster team, and billers they ensure that they are charging and billing compliantly while maximizing revenue and reimbursement at the same time.

“When I first started our revenue integrity team, our job was to be the liaison between the clinical world and the business world of the hospital,” says Rosier. “Then in 2012 when we implemented EPIC, I inherited the charge capture staff as well.”

Today, the revenue integrity department’s goal is to ensure clinicians are documenting and charging for all services they provide. Any errors are communicated back to the appropriate team to correct. For example, if a PICC line insertion was ordered and documented as completed, but there was no charge on the account, it would hit an EPIC Revenue Guardian check for a missing charge. Rosier’s team would review the chart and add the charge, if applicable, and then educate the clinician as to how he or she missed the charge. By educating the clinician when charge error trends are found, the hope is to reduce such errors in the future.

Rosier shares the following five tips that have helped her team facilitate revenue integrity:

1. Use your existing EMR system or adjunct technology to help you find accounts that have missing and/or inaccurate charges. Work with the system you have, advises Rosier. Whether you use EPIC or Meditech, leverage your data analytics software to alert your team of missing charges. Set up work queues to flag patterns in your system where there are codes linked to multiple missing charges. Additionally, set up work queues to catch high-dollar and/or high-quantity errors, such as charging 10 of a procedure instead of one.
2. Work with your billing department to look at claim edit trends. Your billing department has scrubbing systems to identify incorrect revenue codes, NCCI edits, or errors in dates of service. Use the edit trends to your advantage. “One of the first things that I did was work with my billing department to see what type of claim edits they were hitting on a regular basis and then set up work queues to find those accounts before a claim was created,” Rosier says. Finding charge problems before a claim is created in your system prevents a lot of rework and inefficiency downstream.
3. Identify missed charge capture opportunity through doing onsite visits. The best way to understand how clinicians are providing care and documenting is to observe them firsthand. Ask the end-user what’s missing or causing them problems. If your revenue integrity team can simplify the documentation process, it has the opportunity to improve clinical workflow. “Don’t just ask over email or phone—observe patient workflow firsthand to see what’s being documented and charged, to see what could be missing, and then fix it on the front end,” says Rosier. “More times than not, if I’ve relied on what the manager says is happening, it isn’t always the case.”
4. Build a relationship between your revenue integrity team and clinicians. While it’s important to problem-solve documentation issues, the revenue integrity team should not be telling clinicians what to do. Instead, the relationship should be a two-way street. “It’s really a collaboration between our team and the clinicians,” says Rosier.
   For Rosier’s team, the relationship between revenue integrity and clinicians is improved by the fact that most of her revenue integrity analysts have some clinical experience (e.g., nursing, coding, radiology) and can speak to clinicians in a language they understand.
5. Find the root cause of the problem and go back to fix the problem on the front end. Don’t keep fixing the same error on the backend. Take the time to educate clinical staff. If your revenue integrity team sees that a clinician has missed repeatedly documenting a contrast charge for a CT scan with contrast, take the time to educate him or her. Your clinician may just be new and unaware of the proper documentation. Additionally, put in a reconciliation step. For example, to monitor CT scan charges, the CT lead technician in imaging should monitor the schedule and revenue usage report daily to ensure every patient was appropriately charged. He or she should also be scanning the report for common errors.

Meanwhile, if the correct charge is not set up in the chargemaster, take the steps to update your chargemaster. “We work with clinical leadership to submit new charge requests to our chargemaster team,” says Rosier. “Once we determine how to charge a service and it is set up in the chargemaster file, we then work with our EPIC team to ensure it is accessible for clinicians to charge and/or document as well.”

As the importance of revenue integrity continues to grow, clinicians will continue to ask: “how do we charge this?” Your department must ensure it takes the time to set up a system that meets the needs of your facility. Understanding your EMR and charge capture system, establishing checkpoints, and looking for trends will help you facilitate accurate charge capture.