What Is Charge Capture and How Charge Capture Audits Streamline the Process

Today’s healthcare industry has evolved by leaps and bounds. By introducing intuitive technology in medical administration and billing, many prominent healthcare institutions are now able to achieve their financial and caregiving goals effectively. However, reimbursements do not come in easily. Even with the inclusion of AI-powered technology, the medical billing industry faces payment issues. Inaccurate charge capture is the culprit in most cases. 

Charge capture is an essential function of the medical billing system in which chargeable medical services, procedures, and the related equipment and supplies are documented and accounted for during the claim process. This article explores why medical charge capture matters in the revenue management system. We also highlight how charge capture audits play an important role in optimizing and streamlining the process.

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What Is Charge Capture In RCM?

Timely reimbursements are crucial to ensure the sustenance and longevity of many functional RCM systems in modern healthcare. It is a very important aspect of healthcare revenue management. With intuitive technologies like AI and machine learning being incorporated into mainstream medical administration, several tasks are automated, allowing medical billing professionals to focus on fine-tuning the more critical aspects of the industry, such as charge capture. 

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Charge capture in medical billing is the action of documenting, recording, and entering accurate cost details of billable medical services and the equipment and supplies associated with them.

To simplify, charge capture ensures:

1. Every service performed is documented accurately.
2. Every documented service is billed.
3. That accurate documents supporting the medical necessity of a procedure are uploaded to the system.

Although it may seem like a minute function, charge capture sits at the intersection of clinical care, medical coding, and billing, making it a crucial revenue cycle function.

Relevance Of Charge Capture In Healthcare

Modern healthcare has evolved in several ways over the years. With increasing disease complexity and a surge in ailing populations, there is more demand for technological solutions that help caregivers strike a balance between accurate care delivery and financial management. Charge capture, when done correctly, can contribute to timely reimbursements by justifying the relevance of a medical procedure with supporting documents.

Inaccurate charge capture can result in:

1. Lost revenue due to missed charges.
2. Claim denials due to undercoding or gaps in documentation.
3. Delayed payments owing to documentation rework or pending submissions.
4. Compliance risks associated with undercoding or overcoding.

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The current economy is unforgiving, especially for healthcare providers. With medicines and procedures getting costly, hospitals are more reliant on receiving timely reimbursements now. In such a situation, it is essential to invest in training healthcare billing and coding staff to ensure optimized billing and claims processes.

Common Challenges in Charge Capture

Ideally, accurate charge capture can be beneficial for hospitals and other caregiving organizations. The reality, however, is far from perfect. One of the major challenges the healthcare billing industry faces today is to manage uploading various documentation. A missing piece of paperwork highlighting the need for certain medical services can cost a hospital their timely payment, affecting workflows and resulting in significant losses. This is where timely charge capture auditing comes into play.

What Is Charge Capture Audit?

In any organization driven by workflows, timely audits ensure that certain functions are conducted in adherence to the compulsory regulations laid down by authorities. A charge capture audit is no different. Charge capture audits help in optimizing the medical billing system to produce the desired results while ensuring that the procedures comply with the healthcare rules and regulations described by governing bodies. Here is how these audits help in streamlining the charge capture process, in turn enabling a positive change in the overall financial functioning of the hospital.

Audits help identify missing and underreported charges

Intuitive auditing software analyzes clinical notes and related medical literature to detect which chargeable medical service was not accounted for. This is done in compliance with healthcare billing regulations. The feedback helps medical billing teams to assess and evaluate their workflows for charge capture flaws and repair them, optimizing the workflow and improving the chances of receiving timely reimbursements.

Improve Documentation Quality

Timely charge capture audits help billing teams identify the gaps in documentation and optimize their workflows to check for missing information, saving time and effort. Audit reports provide a well-researched analysis of the current documentation workflow, allowing teams to make effective decisions.

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Reduce Coding and Billing Errors

Charge capture involves assigning CPT codes accurately to corresponding medical procedures. Incorrect coding is a major reason why many medical bills are not approved by payers. With charge capture audits, billing teams get a detailed analysis and data-based inputs, allowing them to correct mistakes and optimize workflows immediately.

Standardize Charge Capture Workflows

These audits are carried out by industry experts who have been studying, analysing and devising effective workflows that follow a standardized approach, making it widely accepted and available. Their suggestions can help hospitals and other caregiving institutions not only correct existingcharge capture workflows but also ensure that these are standardized and optimized for better feasibility.

Support Compliance and Risk Management

Charge capture audit helps in ensuring that medical services are accurately billed, leaving very little scope for errors due to overcoding and undercoding, reducing compliance risks and payer conflicts.

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Enable The Inclusion of Technology For Optimized Operations

Regular audits help healthcare management assess and understand where to include intuitive technology that can help in streamlining charge capture workflows.

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Charge Capture Audits and Modern RCM Systems

Healthcare analytics is slowly proving to be an irreplaceable asset in the industry, paving the way for a more intuitive and care-based approach to healthcare financial management. Modern RCM systems make use of AI and related technologies like machine learning and deep learning to assess, analyse and identify billing patterns. These systems provide actionable insights to optimize the charge capture workflow accurately. Charge capture is one of the most important aspects of the modern RCM system. Optimizing capture workflows can be a giant technological leap for service providers, enabling them to handle higher volumes of data while ensuring accurate capture, categorization, and ultimately, documentation. 

Using tools such as RapidClaims AI-powered RCM to optimize charge capture workflows can:

1. Help in detecting and correcting coding errors – mismatched codes, inaccurate descriptions, etc.
2. Machine learning parses clinical notes to identify coding errors and missing procedures.
3. Analyses current documentation and suggest actionable insights that can help in streamlining charge capture workflows effectively.

By combining audits with technology, hospitals can ensure accurate charge capture, leading to streamlined workflows and accurate documentation for claims processing. Payers get to refer to clean documentation and accurate coding while assessing a healthcare provider’s worthiness to receive reimbursements.

Conclusion

Charge capture is an important function of healthcare RCM systems. It ensures that all medical services are accurately documented and eligible for billing as per healthcare regulations. By optimizing this step, billing teams are enabled to submit standardized bills while registering for reimbursement. Clearly defined services also allow payers to have a clear picture of the treatment method, thereby reducing the chances of hard claim rejections. Using AI-powered tools such as the RapidClaims RCM systems provides a holistic view of every phase in healthcare billing. This aids in making charge capture audits easy, efficient and effective. Charge capture audits are essential in ensuring effective reimbursement. Timely audits help healthcare providers to understand the gaps in their billing and administration systems and optimize them, resulting in successful billing cycles and reimbursements.

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FAQs

What is charge capture in healthcare billing?

Charge capture refers to the accurate documentation and recording of medical procedures and services provided by hospitals to patients. In charge capture, billing personnel need to ensure that the CPT codes match the provided medical service. It is crucial in ensuring a steady revenue flow, thus contributing to the overall financial well-being of an organization.

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What happens when Charge Capture is incomplete?

Inaccurate charge capture leads to lost revenue, undercoding, and hard claim rejections. This can cause financial drain and disrupt the billing process.

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What is a charge capture audit?

Charge capture audit refers to the timely analysis of charge capture workflows by industry experts in healthcare compliance. It is required to ensure that billing workflows are carried out in compliance with existing healthcare rules and regulations. Charge capture audits help in highlighting crucial errors in workflows and enable teams to work on solutions to correct these errors.

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How often should charge capture audits be performed?

Most healthcare organizations conduct charge capture audits monthly or quarterly. High-volume departments may benefit from more frequent or continuous audits.