In the complex landscape of healthcare reimbursement, charge capture accuracy directly impacts the financial health of organizations. Unfortunately for these organizations, many providers only discover charge capture issues after claims have been generated and submitted, and often when denials or underpayments start rolling in. This post explores why identifying charge capture issues pre-bill, rather than post-claim generation, is a huge benefit for organizations looking to reduce re-work and improve cash collections.
The Cost of Missed Charges
Charge capture is the process of translating healthcare services into billable charges. Errors in this step, such as missing or incorrect codes, late charges, or unlinked documentation can lead to revenue loss. In fact, according to HFMA, hospitals lose millions annually due to incomplete or inaccurate charge capture, and we have seen this first-hand at nearly every client we have worked with. Often, these errors are only caught after the claim is submitted, when payers deny payment.
By this point, it’s often too late, or too expensive, to recover the lost revenue. That’s because of the incurred costs an organization faces when issues are identified after claims are generated. Here are some reasons why:
- Time-consuming rework: Claims must be corrected and resubmitted, requiring manual labor and creating workflow inefficiencies.
- Compliance risks: Retroactive changes can raise red flags during audits and may trigger investigations or penalties.
- Delayed cash flow: The longer it takes to identify and correct issues, the longer it takes to get paid. Cash is king.
What Softek Panther Can Do
The reason many vendors focus on running charge edits on claim information such as 837 files is simply because they are not plugged directly into the electronic health record system. After all, using data such as 837 files does have its benefits – it means that their products can run against data no matter the EHR the client is using.
What makes Softek Panther different is that we only work with Oracle Cerner hospitals and have a real-time connection to the Oracle database. This allows us to get data such as patient’s charge information from the source of truth, the clinical EHR, and identify revenue integrity issues pre-bill and even while the patient is still in the hospital.
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.
Let’s talk about how you can get the most out of your Oracle (Cerner) Millennium® system.
