Healthcare spending is predicted to increase to nearly 21% of the US economy by 2021. For healthcare providers this means greater demand for services but doesn’t guarantee increased payments. While patient volume may increase, per unit payment structures will likely decrease. In fact, payers have leveraged technology to make it more difficult for providers to get paid. Viability in today’s market requires a well-managed, proactive revenue cycle.
Charge capture and charge reconciliation are vital processes for revenue management. Many successful organizations have put charge capture teams in place to monitor the process of charge capture and reconciliation. These teams provide the revenue producing departments with feedback and training to enhance an atmosphere of organization-wide accountability. High performing hospitals develop clear policies and procedures for all staff and provide training to ensure that the charge capture team understands their role in the revenue cycle. They do this by providing timely and meaningful feedback and making staff at all levels accountable for performance. Common reasons for charge capture problems:
- Lack of sufficient training – Do all team members understand and follow the policy?
- System Limitations – Are all orders up to date? Do charge capture tools support timely entry and reconciliation?
- Computerized Physician Order Entry – Who is responsible?
- Unmonitored Daily Department Revenue Reports – Is there a daily dashboard that monitors revenue by department? Is there clear accountability?
Since every charge is potential cash, organizations need to understand the common factors resulting in lost charges. The CDM should be reviewed for:
- Consistent / Accurate / Optimal Pricing
- Inactive / Obsolete Charge Codes
- Use of Miscellaneous Charges – Pricing Overrides?
- Revenue Codes / HCPCS-CPT4 codes – Up to date and compatible?
Your organization needs to prepare now for diminishing revenue streams. Well-functioning charge capture processes and disciplined accountability will help your organization weather the storm.