Get in sync with IT to solve charge errors

Wednesday, January 15, 2020

It’s all too easy to enter an erroneous charge—or miss an appropriate charge—but correcting charge errors is a more complex puzzle. Without the right clues and some teamwork, revenue integrity staff can find themselves searching for a solution in the dark.

Jennifer Grayson, director of revenue integrity at Renown Health in Reno, Nevada, established a charge error correction team that takes an interdisciplinary approach to resolving errors and fixing root causes. They lead the charge error correction process Grayson developed after getting feedback from her team that it was often difficult to determine who was responsible for fixing these errors. Although revenue integrity was often the first to spot errors, stakeholders such as other revenue cycle teams, clinical department leads, and IT needed to work together to resolve them.

“To address it properly, I knew there needed to be a variety of revenue cycle leaders involved to determine how best to investigate a suspected problem,” she says. “Revenue integrity lives and breathes by our charges, but if there's an error involved it certainly doesn't live solely within revenue integrity. It became apparent early on that I needed help from various areas across internal audit and compliance, as well as all of our revenue cycle teams.”

Getting the process off the ground didn’t happen overnight. Grayson wanted to ensure that the process would effectively address charge errors, and have the support of leadership and the staff who would be part of the process.

“It took us several months and the support from my leadership at the time to get everyone on the same page with each necessary step to the process,” she explains. “It was a passion of mine from the very beginning to find a process that would work, not just from a billing perspective or a charging perspective, but from that very critical clinical point of view as well.”

So what does the process look like? Charge errors are generally identified in a few ways. Grayson’s revenue integrity coordinators spot charge errors when reviewing clinical departments’ revenue and usage. They’re also uncovered during daily work queue management and internal audits. Clinical departments also self-identify charge errors. Essentially, anyone who suspects a charge error has a duty to report it to the charge error correction team, Grayson says.

Once the suspected error is reported, it’s vetted by a revenue integrity coordinator, revenue integrity specialist, or billing compliance. If that staff member verifies that a charge error occurred, it’s then passed to the charge error correction team, which is responsible for deciding how to compliantly fix the error, according to Grayson.

Renown’s charge error correction team includes representatives from the following teams:

  • Billing compliance
  • Billing office leaders, facility
  • Billing office leaders, professional
  • Finance
  • HIM and coding leaders
  • Revenue integrity

Consensus is key, Grayson says. All parties involved in the error must understand and support each step in the correction process.

Although IT isn’t part of the charge error correction team, they’re key players throughout the process. Grayson worked with IT to develop charge error correction templates and custom intake forms for reporting suspected charge errors. In addition, some charge error solutions might call for tweaks to the EHR or other systems that IT is responsible for executing. These forms and technical fixes are key to keeping the charge error correction process going and mean IT is a valuable ally.

“IT are our partners in identifying the correct solution, which is key to ensuring any suspected mistakes are prevented from repeating themselves,” she says. “Having trust and a clear explanation of the problem helps to ensure that the right solution is implemented.”

But at many organizations the IT department is already swamped with requests. Revenue integrity leaders might discover that their IT department is hesitant to take on additional responsibilities. To ease IT’s concerns, be clear about what you’re asking for, Grayson advises. If you need IT’s help to address the root cause of a charge error, be clear and specific about what the error is, the source of the error, and the impact it has. Explain why the request is urgent—make a business case for fixing it sooner rather than later.

“It's really up to us to illustrate the compliance perspective, the risk perspective, the source of the error, and why we feel it took place,” Grayson says. “We've personally built a very close relationship with our IT leaders in revenue cycle, so they fully support this effort. I think it really boils down to helping them understand the problem at hand and then them recognizing that their piece to this correction is to provide us the most efficient resolution.”

Renown uses Epic for its EHR and the organization strives to adhere to Epic’s Foundation System, an Epic community where organizations share best practices and tools, according to Grayson. Therefore, any changes to the EHR need to be held to that standard and can’t compromise the system’s integrity or other functions. Respecting and understanding IT’s overall goals and working within their parameters goes a long way to winning their support.

“I think it's an important reminder to the operations side of the healthcare business that we need to lean on IT as the experts in their area just like they would rely on us to be the experts in terms of billing compliance and charge integrity,” she says. “I think it's setting that ground rule right from the get-go. Once all parties feel comfortable knowing everyone’s done their homework right out the gate, the buy in comes naturally. Once everyone has an understanding of the suspected error, why it took place, and the impact it has, we can feel confident that we’ll get the support we need from IT and the clinical areas affected. It’s teamwork at its finest, when you need it the most—that’s what I love about this process!”

Editor’s note: Information in this article was adapted from “Charge Errors: Best Practices for Discovery and Correction.”