How to Maximize Revenue Capture with Low Costs, High Quality
By - Charge capture is one of many moving parts within the greater healthcare reform machine. It is a vital piece that encompasses a string of financial challenges. As RevCycleIntelligence.com wrote, as healthcare consumers attain greater power and increased responsibility regarding the type and quality of healthcare they receive, the future of revenue cycle management as it relates to cost continues to evolve.
Jason Fugleberg, RN, BSN, Vice President of Patient Services/Chief Nursing Officer at Millinocket Regional Hospital, a Critical Access Hospital (CAH) in Maine, chatted with RevCycleIntelligence.com about how to address primary charge capture challenges to best maximize revenue cycle.
RevCycleIntelligence.com: What is the overall significance of being able to reduce the amount of missed charges? What is the ripple effect?
Jason Fugleberg: The ripple effect comes down to being able to capture more revenue and know what supplies are needed to better care for patients. Some people think, “Well, if you increase the charges in your emergency room by capturing more of that revenue, isn't that hurting the patient financially?"
But the majority of the patients that we see, they're sheltered or shielded by their insurance companies. If you have an emergency room visit and you have any type of insurance, that's only going to cost you so much. If you visit the emergency room once, chances are you've almost met your deductible. We don't see it as negatively affecting the patient.
RevCycleIntelligence.com: What is one primary charge capture problem you’ve experienced?
JF: We offer a stickered system for many supply charges. We have to manually enter in any medications, supplies, procedures that are done. Stickers get lost. They end up on the bottom of nurses' shoes or stuck all over their scrubs. They have Patient A down the left side of their scrubs and Patient B down the right-hand side.
You're really just worried about the patient and taking good care of them. So after you get that patient taken care of and situated, you go back to chart and you have stickers all over you. You start to try and recreate what you've just done in the past two hours. It's very difficult to keep straight, and when in doubt, if the nurses can't remember which patient the sticker went to or if they performed that procedure or not on that patient, they end up not charging for it. It's a broken system that revolves around stickers and memory as opposed to real-time charge capture based on charting.
RevCycleIntelligence.com: To what extent is the ability to properly capture charges a problem?
JF: In our emergency room, we're not missing charges on purpose. We're in there to treat the patient and make sure they get the proper care. It's just that our documentation system right now does not do a good job in capturing what we do in the emergency room.
From a patient perspective, if I'm in the emergency room, a minute seems like an hour. So if we can reduce their visit by – their overall throughput time – by 10 or 20 percent, that makes a difference to me as a consumer and patient.
If your average throughput is 4 hours, and you take 10 percent off of your visit, now my 4-hour visit becomes just over 3 hours. That's time that I get to spend back at home with my kids or less time worrying.
RevCycleIntelligence.com: What top strategies have you developed for strengthening the revenue cycle?
JF: If I charge that I started an 18-gauge IV in the right antecubital, as soon as I charge that in the record, it automatically drops charges for those supplies at point of entry. I don't have to remember it. I don't have to carry around any stickers. You chart what you do and you get credit for it. You're reducing the rework and increasing your efficiency. There is no memory or human error involved.
RevCycleIntelligence.com: What is your top financial goal?
JF: I think our primary financial goal is reducing cost and increasing quality. I don't think anybody's going to cost cut their way out of this difficult healthcare reform that we're in. We're going to have to expand revenue. That means expanding service lines.
It's about expanding service lines and figuring out which ones are revenue-producing. For our community hospital, it's also looking at introducing costs. What service lines are most of value to the community and which ones do we need to say, "Unfortunately, yes, it'd be great to not have to drive 60 miles to get this service, but there's not enough of a community value perspective, so you may have to drive 60 miles and we may not do obstetrics anymore.”
There are so many moving parts in this healthcare reform and within the different economies. We're all struggling in some regard based on the different nuances of our local economy and the healthcare reform. It's a tough business to be in right now. It will stabilize.
