Charge capture: Closing the gaps

Charge capture — sounds easy enough. A provider submits a charge for every office or nonoffice service provided, and the charge is then captured and billed for reimbursement. But if there is a lack of policy and procedure on this essential part of a healthy revenue cycle, practices can lose out big time in revenue for services rendered.

Underreporting

A busy surgeon once told me he felt he was working day and night, yet his income was lower than ever. Further research showed he was not reporting his surgeries to the coding department, which meant he was losing out on reimbursement for dozens of surgeries. He wasn’t actually doing less — he just wasn’t reporting the work he was doing. An interview with the coding department revealed that the department only knew if an unscheduled surgery was performed if the doctor reported it. The lesson: Don’t rely on physician reporting. A busy surgeon has may other priorities, namely patient care, that take precedence over administrative reporting.  

Overreporting

Inaccurate charge capture isn’t always due to lack of charge reporting; sometimes it is due to reporting charges for something that wasn’t done. Nothing can invoke patient dissatisfaction like charging for services they did not receive. In today’s busy world, it’s easy to get ahead of ourselves by documenting before the services are rendered. The lesson: Avoid “pre-loading” of services. Do not assume that the service was rendered before the service was rendered. 

Consider this example: A patient is presenting to the clinic for a routine and repeat injection, so the medical assistant enters the injection charge based on that preliminary knowledge. During the brief exam, the doctor notices that the patient has severe flu-like symptoms and decides against the injection. The patient’s insurance plan gets billed for a procedure that never happened, and the patient receives a bill. This can lead to patient mistrust, complaints and reporting to insurance companies what is, in essence, a fraudulent 
claim — not to mention the administrative cost to correct the error.

Check for correct reporting

Ancillary services, such as labs, drugs and supplies, are a big target for missed revenue opportunities. Make sure your charge master is updated regularly to include all services and supplies performed in your practice and to educate all staff on the importance of proper reporting. The number of units in drugs administered is often an area of concern that can cost thousands of dollars if not reviewed and maintained regularly. 

It is crucial to identify every step of the charge capture, from the point of service to the payment of the service.

One practice audited was reporting the use of Myobloc for patients suffering from cervical dystonia. The practice was billing one unit of Myobloc (J0587 – injection Myobloc, 100 units) but injecting 10,000 units. It was losing the revenue of 99 additional units of Myobloc on each patient, equaling about $1,150 per error. “We really didn’t read the HCPCS manual, we thought one injection equaled one unit,” the practice’s coding department says. This is a very common error. Many practices do not match their services to descriptors in the HCPCS manual, causing costly misreporting. The lesson: Verify all ancillary services in your charge master to ensure charge per unit and that the number of units are being reported.

The takeaway

It is crucial to identify every step of the charge capture, from the point of service to the payment of the service. There is no “one-size-fits-all” answer to this common problem. But creating a step-by-step walk-through of your charge capture that includes all places of service (office, hospitals, physical therapy departments, nursing homes); all ancillary services (drugs, labs, X-rays, supplies); and all services (surgeries, minor procedures), as well as creating a policy for each area that can be monitored and reconciled regularly, is key to accurate charge capture.    

Easy first steps can include making sure every test, x-ray or visit is ordered through your EHR and then reconciling charges to those orders. For hospital surgeries, accessing the hospital’s operating room (OR) report for your providers regularly can reveal missing charges reconciled against the OR log. As you map out your processes, make sure you review them regularly to close all the gaps in your charge capture process. Prevent charge lag by requiring that all charges be submitted within a specified time frame and adhere to it. The longer a charge is uncaptured, the higher chance it has of being incorrect.  

Whether your charge capture process is done via an intelligent charge capture app, an EHR or a sticky note from your provider, it is important to have a formal process in place to avoid improper or inaccurate charge capture that can be costly in a number of ways.