Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

40% of Revenue Cycle Leaders Don’t Discuss Charge Capture Regularly

Charge capture is key to a smooth revenue cycle, yet only one-third of organizations talk about the process weekly and 18 percent discuss it twice a month.

Healthcare charge capture and revenue cycle

Source: Thinkstock

By Jacqueline LaPointe

- Over three-quarters (78 percent) of revenue cycle leaders at acute care organizations agreed charge capture is essential to an organization’s success, yet most leadership teams only discuss charge capture once a month or less.

Those were the findings from a new survey conducted by Sage Growth Partners for analytics company Ingenious Med. Researchers surveyed 104 leaders in a supervisory capacity over the revenue cycle at acute care organizations in 35 states.

Charge capture is the process providers use to get paid for services rendered. After documenting a patient encounter in the medical record, providers or their health information management and coding staff assign codes for claims. Staff then translate those codes into charges.

The healthcare revenue cycle hinges on accurate and complete charge capture. However, the survey showed providers have room to improve the charge capture process.

Only one-third of revenue cycle leaders said they discuss charge capture weekly, while 18 percent talk about the process twice a month. Another two percent of respondents also reported never discussing charge capture.

READ MORE: The Role of the Hospital Chargemaster in Revenue Cycle Management

Provider organizations may want to move charge capture up on their priority lists to prevent revenue losses and reimbursement delays, researchers advised.

Missing charges and charge lag are the top charge capture challenges, according to respondents.

Failing to capture a charge can result in significant financial losses. Despite its impact on the bottom line, about two-thirds of revenue cycle leaders (68 percent) reported that between one and ten percent of their total charges were under-coded, and 20 percent said under-coding impacted 11 percent or more of their charges.

Under-coding charges is a serious issue impacting an organization’s financial health. But the survey also showed over-coding also created trouble for providers.

More than half of the respondents (56 percent) stated that between one and ten percent of their total charge were over-coded, while 14 percent said it is 11 percent or more of total charges.

READ MORE: Maximizing Revenue Through Clinical Documentation Improvement

Over-coding charges may bring in additional revenue for a provider organization. However, the reimbursement is not compliant and major payers are likely to recoup improper payments through costly audits. CMS particularly is bolstering its auditing services to ensure claims are paid properly.

Provider organizations are starting to feel the auditing pressure. Approximately 56 percent of revenue cycle leaders said CMS or another payer audited their organization more than one.

Just one-third of respondents said they have never been audited. Another eight percent were uncertain or unwilling to share.

In terms of charge lag, only about one-third of revenue cycle leaders (32 percent) said their organization captured charges within 24 hours, and just two percent reported charge capture in less than an hour.

Meanwhile, charge capture took one to two days for 25 percent of participants, three to seven days for 35 percent or participants, and over a week for six percent of participants.

READ MORE: Automated Physician Queries Improve Clinical Documentation at WMHS

Lags in charge capture impacted claims submission, the survey also found. The majority of revenue cycle leaders (40 percent) stated that four to seven days typically expire between charge capture and claim submission.

Another 33 percent of respondents said it takes one to three days to submit a claim after charge capture, while 24 percent reported one to four weeks and two percent reported more than four weeks.

Additionally, revenue cycle leaders identified their EHR systems as a major charge capture challenge. Specifically, they cited a lack of integration between EHRs and other technologies.

EHRs are the dominant health IT system used for charge capture, according to the survey. One-half of revenue cycle leaders said they exclusively use the EHR to capture charges, and 84 percent of all respondents rely at least partly on their EHR system for charge capture.

Standalone charge capture solutions exist, but just 28 percent of participants used an electronic, standalone product. The remaining 27 percent still use manual processes to capture charges.

Adoption of charge capture solutions may be hindered by lackluster customer satisfaction. The survey showed that more than half of respondents (52 percent) were detractors based on their Net Promoter Score, meaning they would not recommend their charge capture solution.

Only ten percent of participants were considered promoters and would recommend their charge capture product.

Provider organizations could also benefit from clearer charge capture responsibilities. The survey found that revenue cycle leaders are split on who should be primarily responsible for capturing charges.

Forty-percent of respondents thought physicians and coders should be equally responsible for accurately capturing charges.

But revenue cycle leaders leaned more toward physicians overall. Another 31 percent said doctors should be held more responsible, while 19 percent believed the responsibility rests with coders.

The uncertainty over charge capture responsibility may be resulting in miscommunications between coders and physicians. The survey revealed that 53 percent of revenue cycle leaders have their coding department spend ten to 25 percent of their time tracking down information from physicians.

Another 12 percent of participants said their coders spend upwards of a quarter of their time communicating with physicians.

Charge capture is an integral part of the revenue cycle. Accurate charge capture and streamlined workflows between staff are key to collecting the proper reimbursement in a timely manner.

But provider organizations still face several opportunities with improving their charge capture processes and prioritizing discussions about accurate charge capture is a good place to start.

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