South County Health

Mat Clerrico, CRCR, CSPPM, CSPR

Though many billing complications can affect reimbursement, I’ve found that one of the most consistent challenges within our Revenue Cycle is ensuring complete charge capture when the provider documentation is recorded in one system, but the coding and billing occur in another. 

We are not alone in this struggle, many healthcare facilities and systems utilize different systems for their acute EMR and their ambulatory EMR. Given the complexity of the charge processes and the challenge of interfacing charges between aging systems, it is vital to institute robust charge capture procedures to avoid revenue leakage.

“Given the complexity of the charge processes and the challenge of interfacing charges between aging systems, it is vital to institute robust charge capture procedures to avoid revenue leakage.”

In this article, we will explore some of the most significant challenges, and strategies to ensure better charge capture.

Challenges

Lack of Standardization:  Clinicians, department leaders, and other stakeholders may not be engaged or even directly aware of the intricacies of the charging process for their services. This is particularly true of any automated charging that is set up based on background settings or system triggers.

Hardware/Software Intricacies: Health systems often deploy bolt-on modules or systems for specialty functions, all of which carry their own intricacies and charging procedures. The more highly specialized, or technical the system is, the more difficult it is to set up and monitor charge capture.

Incomplete or Inaccurate Charge Data: Charge data can be incomplete due to a lack of detailed documentation or missing charges, while inaccurate charge data may result from human errors in data entry or coding. These issues can result in under-billing or even over-billing, both of which can cause significant downstream billing headaches.