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Charge Capture Process in a Medical PracticeCharge capture, the documentation of patient visits that take place outside of the healthcare provider’s office, can have a significant impact on provider reimbursement. According to a report in Modern Healthcare, health systems are losing about one percent of their potential annual net revenue due to various issues associated with charge capture – this could mean a loss of up to $8 million annually for hospitals with an annual net revenue of $800 million.

Charge capture is important to: hospitalist groups; consulting specialists who have privileges to a hospital or organization where they see patients, but are not contracted by them; surgeons, ophthalmologists and other specialists who see patients in surgery centers, and document their procedures at point of care.

Being proactive is crucial for proper charge capture. Providers need to have proper internal controls, policies and procedures, and auditing processes in place for this task and also ensure that they are being implemented. The Modern Healthcare report points out that capture of the appropriate charge is fraught with challenges as numerous variables affect the process. These include:

  • Missing or incomplete documentation
  • Lack of knowledge about what can and cannot be charged
  • Overlooking unbilled encounters or missing charges for all services provided
  • Untimely or incomplete updates to the Charge Description Master (CDM)
  • Unexpected visits or inpatient consults, especially if the provider consults at more than one hospital or facility
  • Inconsistent charging practices in the organization
  • Inconsistent charge reconciliation processes
  • Assumptions that the charge is being captured by the system when it is not
  • Constantly changing payer payment guidelines and requirements

Here are some tips to overcome these issues and ensure proper charge capture in medical practices:

  • Have appropriate processes and procedures in place – from patient scheduling to claim submission and collection. Patient appointment scheduling should cover e-visits, inpatient consults, nursing home visits, injections, and nurse visits provided by the practice. Including these in the scheduling software allows reconciliation of charges billed to services scheduled. Creating a proper policy for all scheduling will ensure that fee tickets or charges are not missed.
  • Verify whether consultations were performed or not by keeping track of when and where the providers are on call.
  • Provide education, training and appropriate resources for physicians to ensure that the practice receives the information needed to perform billing functions.
  • Perform charge-capture audits to verify if proper internal controls are in place and implemented.

Charge capture is an important element in the services provided by medical billing outsourcing companies. Professional service providers have a separate team on the job. They will enter charges on a daily basis to ensure that the practice maintains a constant flow of revenue, and also conduct audits to check all charges for completeness and accuracy.