If you’re a healthcare provider, you know how important it is to get paid accurately and on time for the services you provide. But the revenue cycle management process can be a tangled web of codes, documentation requirements, and insurance rules. One of the biggest pain points? Charge capture.
Charge capture is the process of precisely documenting and capturing billable services provided to patients. It’s the first critical step to getting reimbursed, but it’s often an area where healthcare organizations struggle – leading to missed charges, denials, and revenue leakage.
In this guide, we’ll walk through mastering charge capture from top to bottom. We’ll cover the basics of what charge capture means, why it’s so important, and the biggest challenges healthcare providers face. Then we’ll dive into proven strategies and a roadmap for optimizing your charge capture process. Let’s get started!
What is Charge Capture?
At its core, charge capture is all about accurately documenting the services and care provided to each patient. This detailed charge data then gets coded and submitted to payers like insurance companies for reimbursement.
The charge capture process typically includes:
- Recording diagnoses, procedures, tests, treatments, medical supplies used, etc.
- Capturing details like date/time, provider, location, modifiers, etc.
- Matching documented charges to payer-specific coding rules
- Entering compliant charges into the billing system
- Undergoing charge review for completeness and accuracy
Why is Charge Capture So Critical?
Charge capture is the foundation for everything that comes after in the revenue cycle.
Miss charges on the front end, and you’ll experience:
- Missed revenue opportunities and lower reimbursements
- Increased payment delays and denials
- Higher administrative costs for reworking denials
- Compliance risks from improper documentation
- Frustrated patients dealing with re-billings
Simply put, optimizing your charge capture process means more compliant, accurate, and timely reimbursements coming into your organization. On the flip side, poor charge capture leads to serious revenue leakage.
In fact, industry studies estimate that the average large hospital misses out on 1% of its net patient revenue due to missed charges – or upwards of $3.5 million in revenue leak per year. And that’s just the average!
Common Charge Capture Challenges
So why is charge capture such a difficult area to master for many healthcare providers?
Here are some of the biggest reasons:
- Complex Coding and Rules: With thousands of payer-specific billing codes and rules to follow, it’s easy for details to slip through the cracks during documentation.
- Manual Processes: Many organizations still rely heavily on manual, paper-based charge capture – leaving lots of room for human error.
- Disparate Data Sources: Details needed for complete coding exist across EMR systems, nurse notes, doctor notes, schedules, and more. Compiling it all is tough.
- Lack of Visibility: It’s hard to identify charge capture issues, see where leakage happens, and understand the true revenue impact.
- Limited Staff Bandwidth: Meticulous charge capture requires providers and staff who have little extra time to invest.
The good news? These challenges can absolutely be overcome with optimized people, processes, and technology. Let’s look at some proven strategies and a roadmap for mastering the charge capture process.
Strategies for Optimized Charge Capture
While there’s no one-size-fits-all approach, incorporating some combination of the following strategies can greatly improve charge capture performance.
Leverage Automation and Technology
Automation plays a huge role in streamlining charge capture by reducing human touchpoints and errors.
Tools like:
- EMR charge capture automation to automate capture at the point of care
- Intelligent charge routing based on coding rules and requirements
- Charge review software with coding logic to catch missed charges
- Analytics to monitor, report on, and audit charge performance
Many top organizations now use machine learning and AI for intelligent medical coding based on clinical documentation. Talk about accelerating speed and accuracy!
At minimum, removing manual data entry and paper processes is a must. But technology alone isn’t the full solution…
Standardize Processes
Clear, standardized workflows and processes around charge capture ensure consistency across your organization.
This includes:
- Defining explicit expectations and accountability for charge capture responsibilities
- Centralizing charge data into a single system wherever possible
- Streamlining handoffs between clinical and billing teams
- Implementing rigorous charge review and audit protocols
- Outlining escalation paths for issue remediation
Standardized processes eliminate variability and make it easier to identify (and fix) any charge capture breakdowns.
Invest in Staff Training
Your clinical and billing staff are the frontline soldiers executing on charge capture every single day.
Investing in education and training pays huge dividends:
- Make charge capture training mandatory and ongoing
- Have mid-level coders audit and provide feedback
- Circulate coding updates, rule changes, and refreshers regularly
- Consider certification courses from AAPC, AHIMA, or AMBA
- Provide reference tools and documentation resources
An educated, accountable staff will be far less error-prone and make better decisions in gray areas.
Focus on Visibility
You can’t improve what you can’t measure.
Establish robust reporting and charge analytics to gain visibility into:
- Productivity metrics like charges captured by time, location, provider
- Compliance reports highlighting potential risk areas
- Denials and root cause analyses for why charges were missed
- Comparative performance benchmarking
With data illuminating your strengths and weaknesses, you can identify coaching opportunities and focus efforts effectively.
Implement Charge Scrubbers and Edits
To get charges right before they ever go out the door, implement system edits and scrubbers as an added safety net:
- CPT code edits to ensure compliant code assignment
- Automated charge review holds based on rules
- Integration checks between EMR and billing systems
- Other checks based on issues seen in your environment
Pre-submission scrubbing within the billing system itself is your last line of defense.
Consider Outsourcing
For some organizations, particularly smaller practices without dedicated billing staff, outsourcing charge capture makes a lot of sense.
Benefits include:
- Leveraging billing expertise and scalable resources
- Passing liability for coding compliance to the vendor
- Converting to a variable cost billing model
- Gaining access to leading coding technologies
Reputable medical billing services can optimize charge capture, while your staff stays focused on patient care. Win-win.
Let’s Map Out a Roadmap
Talking through piecemeal strategies is one thing – but what does a real, actionable plan look like for mastering charge capture across your healthcare organization?
Here’s a suggested roadmap with key steps to follow:
Step 1: Baseline assessment
Before investing time and resources into optimizing charge capture, you need a clear baseline understanding of current performance, including:
- Quantifying the current rate of missed/incorrect charges
- Analyzing the root causes by provider, specialty, location, etc.
- Understanding the financial and operational impacts
- Assessing existing charge capture processes and technologies
- Identifying key stakeholders who will get involved
This detailed assessment provides the foundation for building an optimization roadmap tailored for your specific needs and challenges.
Step 2: Goal-setting and planning
With baselines understood, it’s time to outline the goals for improving charge capture performance.
These are best established as specific, measurable targets such as:
- Reducing missed charges from X% down to Z% within Y months
- Cutting charge entry costs by $X per encounter
- Decreasing days in AR by X days for charge-related denials
- Achieving X% provider participation in charge capture responsibilities
Then comes the planning phase. Assemble a cross-functional team representing clinical, billing, IT, operations, and other stakeholders.
Have this team build out a comprehensive plan detailing:
- Resourcing, budget, and timeline requirements
- Roles, responsibilities, and accountability owners
- Specific milestones and target deadlines
- Communication and change management plans
- Success metrics and reporting expectations
Rigorous upfront planning ensures focus and momentum.
Step 3: Technology optimization
With the vision and plan established, the first key workstream is enhancing your technology capabilities for charge capture automation, efficiency, and visibility:
- Evaluate adding a new enterprise charge capture and management tool
- Pursue EMR system optimizations and integrations for data flow
- Implement advanced coding automation and AI capabilities
- Build out charge capture reporting and monitoring analytics
- Consider outsourcing all or part of coding/charge entry
Prioritize technologies that reduce manual effort, increase coding accuracy, and provide greater transparency. This lays the foundation for process and workflow improvements.
Step 4: Workflow redesign
Next up is taking a hard look at your current charge capture workflows and redesigning them for simplicity and standardization:
- Map out current state processes by care setting, location, specialty etc.
- Identify points of variation, inefficiency, and potential for errors
- Design future state workflows with a focus on streamlining handoffs
- Clarify ownership and escalation paths for different charge scenarios
- Develop protocols for charge review, audit, and remediation
- Document all standards in a central policy and training resources
The goal is making charge capture incredibly clear and consistent across the board – no more ambiguity.
Step 5: Staff training and rollout
With optimized technology and processes defined, it’s time to ready your staff through extensive training and communication:
- Develop comprehensive charge capture training curricula
- Make training mandatory for all relevant clinical and billing staff
- Reinforce with continuous coaching, auditing, and feedback loops
- Clearly communicate new policies, workflows, roles, and responsibilities
- Cultivate a supportive culture of accountability and ownership
Your staff are the ones who will truly make or break sustainable change, so invest heavily in enabling their success.
Step 6: Reporting and monitoring
All that’s left is fortifying a culture of continuous improvement through robust reporting and monitoring practices:
- Implement scheduled reporting on key charge capture metrics
- Develop monitoring dashboards for centralized visibility
- Conduct regular auditing and denials analytics
- Facilitate accountability checkpoints across teams
- Identify additional optimization opportunities
Continuous reporting keeps charge capture top of mind and ensures the processes and gains made become cemented and enhanced over time.
Commit to Mastering Charge Capture
There’s no sugar coating it – mastering the charge capture process is a major undertaking for healthcare providers. It requires committed leadership, operational disruption, technology investments, and serious culture change management.
But the impact of getting charge capture right will reverberate across your entire revenue cycle. You’ll experience accelerated cash flow, reduced administrative overhead, improved compliance, and less reimbursement leakage. Not to mention happier, more satisfied patients.
By following the roadmap outlined here – assessing baselines, planning, optimizing technology, standardizing workflows, training staff, and continuous monitoring – you’ll be well on your way to charge capture mastery.
It’s a journey, but one that unlocks sustainable financial health for your organization. The time to start is now – your patients and bottom line will thank you.
