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Mastering Charge capture – Comprehensive Guide for Healthcare Providers

Mastering Charge capture – Comprehensive Guide for Healthcare Providers

A healthcare practice’s success ultimately hinges on many interconnected factors. While providing sound healthcare services is the primary and most important aspect of a healthcare facility, several other significant bits are crucial to running a successful practice. Among these is charge capture – a necessary operational activity ensuring that a practice receives timely payments for services provided. An effective charge capture system opens the door to a sound and sustainable revenue stream and plays a pivotal role in ensuring a steady cash flow and enhancing overall patient satisfaction. In this article, we’ll understand what the charge capture process entails, the challenges healthcare practices face regarding charge capture, and the best practices they can adopt to mitigate issues.

WHAT IS CHARGE CAPTURE IN HEALTHCARE?

When a patient first visits a healthcare clinic for an examination and treatment, the physician attending the patient must get the services properly documented. The documented services are then submitted to the insurance provider or another payee (which could be the patient) for payment. Charge capture is the process of accurately recording and documenting the services provided by a physician to a patient. It is also the method used by billing partners to convert claim codes for patient services into charges, ultimately generating revenue for their practice.

Charge capture goes by other names, including Charge Capture Revenue Cycle, Medical Charge Capture, and Healthcare Charge Capture. Charge capture is a fundamental requirement for any healthcare practice as it records services delivered that need to be charged. It plugs any gaps that may cause revenue loss. A smooth charge capture process helps increase the overall efficiency of the practice.

WHAT IS THE PROCESS OF CHARGE CAPTURE FOR PRACTICES?

1.PROVISION OF SERVICE

The charge capture process begins with a physician or healthcare professional providing a medical service, such as a consultation, medication, or advice to undergo tests, to a patient.

2. DOCUMENTATION OF SERVICE PROVIDED

As soon as the service has been provided, the physician or healthcare professional must document the service. The information that must be captured includes the date and time of the patient visit and services directed and/or performed. On a case-to-case basis, additional information may be recorded.

3. ASSIGNING MEDICAL CODES

Once the services have been documented, they are translated into established and accepted medical codes that have been adopted by the practice

4. THE CHARGE ENTRY

Codes assigned as per the adopted coding system are then entered into the system for billing. The entries are marked against the patient’s account, so it is clear which patient received which services and what costs must be paid for these services.

5. REVIEWS AND APPROVALS

The submitted charge entries are then reviewed to establish whether they are accurate and in line with the services provided. In case of any inconsistencies, further information may be requested at this stage. If everything is found to be in order, the charge entry is approved.

6. SUBMITTING CLAIMS

Approved charge entries are submitted to the payee – usually the insurance company of the patient. The claim will include a detailed description of all the medical services provided to the patient with documented proof.

7. INCONSISTENT SUBMISSIONS AND DENIED CLAIMS

The insurance company will process claims submitted and verify the claims and documentation are in order. Claims with issues are studied further, with additional information reviewed. The healthcare service provider may be required to resubmit the claim after addressing the concerns raised by the insurance company. It is possible some claims are denied.

8. PAYING CLAIMS

Once all doubts and issues around a claim are resolved, the insurance company will process the claim and make the payment. Amounts paid depend on several factors, including but not limited to the insurance plan of the patient and the services provided.
The charge capture process encompasses the entire journey, starting from when the patient enters the physician’s clinic to the point when the claim is successfully paid. It includes all the steps involved in recording, documenting, and submitting charges for the services provided to the patient. While it looks relatively simple, the reality is that it is far more challenging.

CHALLENGES IN CHARGE CAPTURE PROCESS

As highlighted above, the charge capture process is quite complex. This naturally leads to several challenges.

Errors and Omissions:

The charge capture process involves several steps. At any step, it’s possible some information, detail, or service is recorded inaccurately, or there is an oversight leading to important information not being submitted, or some other mistake is made during any one step of the process.

Regulatory Changes:

Regulations for healthcare service providers are constantly evolving. This includes coding guidelines, which are incredibly important to get right. Service providers must always be on the lookout for any changes and ensure they are swiftly implemented.

Technological Challenges:

Healthcare providers adopt technology to make their jobs easier. However, many different tech systems exist, and a new platform adopted by your practice may not be fully compatible with other tech systems your practice uses or that the insurance company uses. This can cause unforeseen errors and glitches.

Staff Skill

As we have seen, the charge capture process is quite complex and requires knowledge of coding, regulations, and more. If the staff undertaking this activity are not fully trained, and up to speed, mistakes will be unavoidable.

Communication breakdown:

As can be seen from the steps involved in charge capture, several departments within the service provider, as well as third parties, are involved. This can lead to lapses in communication, which result in delays, errors, and omissions.

Policy changes:

It’s not just regulations that may change – insurance companies and other third-party vendors involved in the process may change their policies and practices around claims disbursement. This would require the healthcare providers to make changes to their own processes to bring them in line with the vendor.
Other challenges include managing the volume and workload and ensuring the practice has enough dedicated resources to carry out the process. These challenges end up affecting the claims process and can lead to rejected or denied claims. Any one of these challenges, if not addressed immediately, can create glitches in the overall efficiency of the healthcare provider, leading to undesirable impact on the bottom line of the practice.

BEST PRACTICES IN CHARGE CAPTURE

As far as charge capture in healthcare is concerned, there is no one-size-fits-all solution. However, when implemented correctly, certain practices can lead to the optimum realization of revenue and patient satisfaction scores while stringently complying with all rules and regulations.

Staff training and education

Healthcare providers may consider regular training programs that ensure the staff dealing with charge capture, including the physicians who kick-start the process, are aware of the latest rules, regulations and requirements.

Get the coding right:

Assigning the right codes for the right services is absolutely critical. Practices can introduce a mechanism that cross-checks assigned codes before submitting claims. Staff training mentioned above can also help prevent mistakes in code assignments.

Proper documentation:

Since recording the medical services provided to the patient is the first step of charge capture, it’s imperative it is done accurately and efficiently. Having a clear system in place, which every physician and staff member knows about, helps. For example, by ensuring the services provided are documented in realtime, the service provider can prevent lapses, delays and inaccuracies.

Technology:

While technology features in the challenges around charge capture, it is also a problem solver. Electronic recordkeeping can help streamline the entire process, with checks and balances being part of the system itself so that they help prevent discrepancies. Electronic recordkeeping is a good way of making sure that no unwanted errors creep in.

Conducting audits:

Conducting regular system audits can help identify holes in the system before they become a problem. Having this in the organization calendar means staff are always aware and prepared to collect the necessary documents and complete the processes as designed

Regulatory checks:

Practices can introduce processes to ensure they are in compliance with regulatory guidelines relevant to their industry.

Setting targets and looking inward:

By setting targets for itself, the practice has a defined goal towards which it works. Each practice is different. While there are common systems and steps that can help most practices, each has its own set of challenges that may be unique to practices of a particular size, in a specific location, or area of specialization. Conducting an internal review will highlight which targets were not met and why. This allows the practice to find solutions for their challenges.

BENEFIT OF OUTSOURCING THE CHARGE CAPTURE PROCESS

Outsourcing your charge capture process can have numerous benefits for your practice. Some benefits are closely connected to others and can have a compounding effect on your overall growth of practice. These benefits include:

Assign work to specialists:

Certain companies that provide charge capture services work with specialists and experts who do the same job day in and day out. These experts are aware of common issues affecting the charge capture process. They know how to deal with exceptional circumstances that they may have experienced while working with different service providers. Using these specialists means expertise is available to you, allowing your practice to benefit.

Cost savings:

Paying an outsourcing company may seem expensive. But it leads to savings in the medium or long term. Outsourcing capture charge means your practice will not have to hire specialized staff, purchase expensive technology, or conduct regular training exercises in the same manner as it would have to if the entire operation was being conducted in-house.

Reduced staff concerns:

With staff focusing on their core jobs, they are more motivated and dedicated to their job. It also reduces the chances of errors as staff isn’t expected to do something beyond their original scope of work.

Technological advantage:

Charge capture specialist companies are set up to provide expert service. Consequently, these companies update their software and processes regularly. This, in turn, means that they operate with maximum efficiency.

Fewer rejections and denials

A natural progression of improving the entire charge capture process is that your practice will benefit by receiving payments from insurance companies faster, sooner, and more efficiently.

Managing high volumes:

Sometimes, a practice may see higher volumes of patients than other times. With more work and the same number of staff, this affects the overall efficiency of operations. By working with an outsourcing company, the amount of work to be completed in-house is more manageable.

Reporting and analysis:

Outsourcing companies can be directed to provide specific records or reports so you may better understand your own practice. By having an in-depth view, you can make informed decisions that have a positive impact on the practice.

Regulatory compliance:

Falling foul of regulators is any medical practice’s worst nightmare. By working with an outsourcing company, your practice will get updates on the latest amendments to regulations, medical codes, etc.

Each of the above advantages directly impacts the efficiency and operations of the healthcare practice. They contribute towards better revenue generation and ensure a healthy bottom line – what every medical practice aspires for.

CONCLUSION

Charge capture is an integral part of a healthcare practice. It is a separate area of specialization that requires experts with the right skills and experiences to carry out tasks.

While healthcare service providers and practices are free to carry out charge capture activities in-house, it comes with its own set of challenges and difficulties. By outsourcing the critical function of charge capture to specialized organizations that are dedicated to this task, healthcare providers are not only making an investment in the growth and success of their practice, but they are also making an investment in their own peace of mind.

Picture of Priyanka Rana
Priyanka Rana

MBA in Finance & International Business, Masters in English Literature

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