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 repeating work. Instead, apply lessons learned from data analytics and back-end processes to help clinical staff capture the correct charges from the start.
Managing charge capture in a multi-hospital system that spans a variety of service lines and charges can prove to be a daunting task both in terms of ensuring claims are accurate and ensuring team members are well versed in each service line and charge type. While some health systems may train staff across all areas of charge capture, Saint Luke’s Health System in Kansas City, Missouri, opted to assign each team member a role in which they could become experts.
At Grady Health System in Atlanta, monitoring key performance indicators (KPI) always comes back to the foundation KPI: hospital late charges. The timing of posting charges has a ripple effect. The longer you wait to post a charge, the more likely it is you will miss something.
In the game of tug of war, will it be clinical or revenue integrity staff members who stand up to the challenge? When it comes to charge capture, it can be a struggle to know who should be held accountable.
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.
As revenue integrity departments continue to evolve, facilities are often faced with the challenge of determining which tasks must fall to these departments and which are best suited for other revenue cycle roles. With so many department functions overlapping, defining revenue integrity-specific functions is a complex task.