Chris Lanaman, Executive Director, Professional Services

Maximizing Revenue Integrity: Ensuring Comprehensive Charge Capture in Healthcare Organizations

In the complex landscape of healthcare finance, one of the crucial challenges hospital organizations face is capturing all charges accurately. Revenue integrity is the cornerstone of financial stability for healthcare facilities, ensuring that every service provided is correctly billed and reimbursed. For the revenue integrity audit team, the task of ensuring all charges are being properly captured is both essential and multifaceted.

The Importance of Comprehensive Charge Capture

Accurate and comprehensive charge capture is vital for multiple reasons:

  1. Financial Sustainability: Hospital organizations heavily depend on the revenue generated from patient care services to cover operational costs, invest in new technologies, and provide quality care. Unbilled or under-billed services can lead to significant revenue leakage, compromising the financial stability of the organization.
  2. Compliance and Regulatory Requirements: Healthcare regulations are intricate and evolving. Accurate charge capture ensures that the organization complies with billing guidelines set by government agencies and avoids penalties or legal issues arising from billing errors.
  3. Patient Trust: Accurate billing contributes to patient satisfaction and trust. Patients want transparency in their medical bills and are more likely to trust an organization that demonstrates a commitment to fair billing practices.

Challenges in Charge Capture

Several challenges can hinder comprehensive charge capture:

  1. Complex Service Offerings: Hospital services encompass a wide range of treatments, procedures, and tests, so it’s easy for charges to be missed or inaccurately recorded, especially if your Electronic Medical Record/Electronic Patient Record (EMR/EPR) is not built to accommodate these offerings.
  2. Fragmented Documentation: Incomplete or fragmented documentation of patient encounters can lead to missed charges. Different departments might record information differently, leading to discrepancies in billing.
  3. Coding Errors: Accurate coding is essential for correct charge capture. Coding errors can occur due to misinterpretation of medical records, leading to under-billing or over-billing. Denials based on incomplete or incorrect coding can be very costly to an organization.

Strategies for Effective Charge Capture

The revenue integrity audit team plays a pivotal role in addressing these challenges. Below are several strategies to enhance charge capture effectiveness:

  1. Cross-Department Collaboration: Foster collaboration between clinical departments, billing, and coding teams. Regular communication helps streamline documentation processes and reduces discrepancies.
  2. Continuous Training: Provide ongoing training to clinical and administrative staff on accurate charge capture, documentation, and coding practices. In Panther, this comes in the form of the Charge Reconciliation suite. Education ensures that everyone understands the importance of their role in the revenue cycle.
  3. Regular Audits: Implement regular internal audits to identify gaps in charge capture. These audits can uncover missed charges, coding errors, and documentation inconsistencies that need to be addressed. Panther has a Charge Capture tool that can assist with this process.
  4. Clinical Documentation Improvement (CDI) Programs: Establish CDI programs to improve the quality of clinical documentation. These programs are included in the Form Integrity tool in Panther. Accurate and detailed documentation directly impacts correct charge capture.
  5. External Reviews: Periodically engage external auditors to review charge capture processes. An external perspective can help identify blind spots that internal teams might overlook. Softek offers Charge Surveillance Services to do these types of audits.

In the intricate ecosystem of hospital organizations, comprehensive charge capture is an essential component of revenue integrity. Softek’s Panther software gives Oracle Cerner clients real-time visibility to see which charges are occurring and which are not within these Millennium systems. Our independent software for Millennium systems allows healthcare teams to follow all the necessary strategies for effective charge capture. For the revenue integrity audit team, ensuring that all charges are accurately captured is a complex and critical task. By fostering collaboration, utilizing technology, and maintaining a commitment to training and improvement, this team can play a significant role in optimizing financial outcomes, ensuring compliance, and maintaining patient trust. Ultimately, their efforts contribute to the financial sustainability and success of the entire organization.

What does Softek® do?

Softek’s mission is to help hospital systems maximize their investment in Oracle Cerner Millennium®. We do this by providing innovative software solutions and consulting services that can achieve more together than either can alone.

At Softek, our team of innovators and software developers brings expertise beyond the ordinary to every client. Our experts are involved with Oracle Cerner Millennium® hospitals throughout the country, consulting clients so they can optimize system performance and revenue integrity.

Softek delivers a full suite of consulting services and software solutions to assess and optimize EMR system performance, including revenue cycle integrity and patient accounting.

Softek was awarded 2021 Best in KLAS for Revenue Cycle Optimization.

Let’s talk about how you can get the most out of your Oracle Cerner Millennium® system.