Q&A: Developing a charge capture audit process

Wednesday, September 9, 2020

Q: What tasks and policies should be covered in a charge capture audit process?

A: Charge capture audits allow review of claims against documentation in the medical record and ensures accurate coding is applied. In addition, the audits can help identify opportunities for improvement and feedback on performance to various departments. The following tasks should be included in an effective audit policy and process:

  • Develop a comprehensive audit schedule that includes a sample of various departments.
  • Perform regular audits based upon the schedule established.
  • Include reviews specific to pharmaceuticals to ensure accurate capture of items such as National Drug Code, procedure and revenue codes, and units of measure. These audits can be driven by specific areas, such as the following:
    • Review of high-priced pharmacy items to verify coding accuracy
    • Review of denied and corrected claims for reasonableness of volumes
    • Review of a sample of medications administered to confirm that they are supported by the appropriate order
  • Provide feedback to the appropriate department based upon the audit outcomes to allow for process improvement.
  • Where necessary, include development of billing or claim edits to allow for correction prior to claim submission.
  • Provide support and/or direction in developing action plans to prevent issues identified.

For more information, see the CHRI Exam Study Guide.