Charge Capture

Correctly acquiring and assembling the information used in medical claim documentation is critical to ensure that your facility receives payment for all the services it renders to a patient and avoids CMS or OIG audits. A predictable and accurate Charge Capture process is the first step taken to safeguard against incomplete or invalid coding, which often leads to lost revenue or denials.

  • Do you have a strategy to insure that all charges are captured on services performed?
  • Do you regularly perform audits of the charge capture process?
  • When was your last chargemaster and pricing review performed?
  • Do you know if your chargemaster is compliant and up to date?
  • What is your current lost charge ratio?
  • Do you have an internal expert who sets and reviews all new orderables & performables?

Charge Capture

Business Challenge:

Failure in the charge capture process jeopardizes facility revenues, hampers cash flow, and risks noncompliance and community dissatisfaction.

The Office of Inspector General of the Department of Health and Human Services OIG) reports that it is doubtful any hospital in the country is billing correctly for APCs, especially in the area of drugs.

The Center for Medicare and Medicaid Services (CMS) has noted a number of instances in which hospitals have not billed correctly for services. CMS has acknowledged their own errors in the payment for these services and subsequently requested hospitals to resubmit the affected claims.

Incomplete Charge Capture processes introduce significant risk to reimbursement, cash flow, and the facility's financial health.

  • Charges are missed due to inaccurate CDM
  • Treatment is provided but charges aren't captured correctly
  • Legacy paper-based processes introduces numerous inefficiencies
  • A shortage of skilled personnel, combined with manual and ineffective process prevents timely DNFB reduction

Best Practices

Healthcare reform law will trim the ranks of the uninsured and in the process could reduce the risk of a facility's bad debt. However, reform will do little to alleviate pressures on the revenue cycle as reimbursements are reduced and patient's deductibles increase.

The continued evolution of healthcare law will further complicate the revenue cycle through the requirement to cultivate an alignment with physicians and bundled payments. Facilities must manage the revenue cycle from both the hospital and the physician side and coordinate processes within financial clearance, eligibility, and price estimates.

Reliance on clinical or support personnel whose primary job is patient care to properly capture treatment charges, hospitals should consider hiring or training charge specialists and building expertise in specific clinical areas to ensure charges are posted correctly, and completely. However, shortages of qualified personnel in rural communities, introduces risks rarely experienced in large metropolitan settings.

Staff should consider running predictive or analytic quality checks to prevent errors and add charges that often go unrecognized.

Streamlining the charge integrity process with better workflow processes will reduce rebilling, late charges, and the confusion often experienced by payors. Concurrent processes work better than retrospective reviews and helps reduce claim review cycles and subsequent reimbursemen and all process should be documented and periodically reviewed.

Services

re|assess

Revenue Cycle Assessment

The revenue cycle challenges faced by hospitals today are enormous. Charge Capture, Coding, reimbursement and compliance issues plague larger facilities as well as rural and community hospitals. Resources to ensure appropriate reimbursement for services provided are stretched. re|assessre|solution’s revenue cycle assessment provides the foundation to optimize your revenue cycle and performance. <more>

re|source

Interim Staffing

Hospitals are constantly struggling with retaining qualified personnel (particularly with smaller community hospitals).  Replacing key personnel in the business office may require training existing personnel and establishing procedures and policies that enhance a new manager’s ability to perform.  Occasionally, locating a new employee takes time to find a good fit.  The facility may not have the luxury of reduced cash flow while recruiting takes place.  re|solution has qualified and experienced personnel ready on a moment’s notice to assist as Business Office Managers, Coders, Billers, Collectors and Cash Posters.  Business office interim staff are placed on-site for as long as they are needed. <more>

re|store

Insource Your Business Office

The regulatory atmosphere and relentless pressure of increasing complexity combine to create staggering challenges while introducing risk to your facility's ability to get paid for the services you are expected to deliver to the community.

  • Increased federal and state regulatory, oversight, and audit pressure continues to drain resources and cash from hospitals while these same agencies increase their focus on billing and coding compliance, often issuing stiff penalties
  • Reductions in reimbursement, increasing self-pay or higher deductibles combine to make cash collection critical
  • Revenue and cash collection are increasingly put at risk due to inadequately trained staff, the inability to afford the best technology and tools, and the struggle to implement and maintain best revenue cycle practices

Your facility has a significant investment in a billing system but does not have the personnel available to adequately manage and staff the business office under this ever-changing environment . re|solution performs all business office functions using your facility's existing billing software and utilizing a mix of your staff, our experienced personnel on-site and from one of our regional billing centers. This treatment is most effective in managing business office costs and relieving billing headaches, without the added expense of replacing your existing system. <more>

Benchmark

How does your facility compare nationally with other facilities of your respective size?

re|solution is an expert in rural, community, and critical access hospitals, providing superior accounts receivable management, revenue cycle analysis, training, charge capture reviews, interim staffing, and an array of other business office services.  If you are interested in knowing how the performance of your business office compares with demographically similar facilities and where your opportunities exist to increase CASH. Please complete the form below and return it to us by fax or e-mail.  In return, we will provide you with a free benchmarking analysis.  We will also make ourselves available for a discussion and explanation of the data. You may view a Sample Report.

Benchmark Indicator Analysis

Please click to complete the Benchmark Indicator Analysis online and we will return your results to you shortly. Your information is confidential.

If you prefer you may print and complete the form and Fax to (303) 847-0417 or e-mail to analysis@ereso.com.

Case Studies

Dallam-Harley Counties Hospital District increases cash and reduces expenses

In partnership with re|solution, Dallam Hartley deployed re|store™. re|solution placed a Revenue Cycle Manager onsite to assist with training current staff, securing additional staffing, stabilizing the DNFB and billing. The staff worked aggressively to meet milestone goals.

Ohio Valley Medical Center and East Ohio Regional Hospital find over $16 million in Net Revenue

Ohio Valley Medical Center deployed re|assess™ complemented by an experienced re|solution BOD to assess staff and staffing levels, provide training and accountability. The re|solution proprietary tools were utilized and left behind for sustainable improvement and success.

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