Reliability Science: Optimizing Revenue with Charge Note Reconciliation and Document Viewing

Is your revenue cycle ‘highly-reliable’ to the point that your physician practice is capturing 100% of the charges you should? The most common answer to that, of course, is “No.”

In fact, Ingenious Med-funded research suggests providers leave an average of 11% of revenue on the table — while 20% of all charges are either under-coded (13%) or over-coded (7%). Further complicating medical groups’ already-stressed financials, the U.S. Centers for Medicare and Medicaid Services (CMS) in November released its 2025 physician payment rule, which includes a 2.83% conversion factor decrease from 2024, and the physician fee schedule conversion factor is down from $33.29 in 2024 to $32.35 for 2025. The American Medical Association responded by saying CMS paying providers less while costs continue increasing is “an unsustainable trend,” and the Medical Group Management Association pointed out that the “final rule throws the financial viability of physician practices into question and threatens beneficiary access to care.”

hospital physician using tablet device
To help physician practices capture more of the revenue they’ve earned, Ingenious Med added new ‘reliability science’ processes to its charge capture technologies. The high-reliability protocols first came in the form of Charge Note Reconciliation (CNR), which the company has now advanced even further with new Document Viewing capabilities that enable doctors and their revenue cycle staff to see clinical notes directly in the Ingenious Med application, without having to authenticate separately into the EMR.

What is highly-reliable charge capture?

The goal in advancing highly-reliable RCM with CNR and Document Viewing, as it is in other reliability science disciplines, is to empower clinicians to succeed at charge capture the first time as frequently as possible, while also understanding that processes will fail at a certain rate. Specific to RCM, physician practices need backup to identify and mitigate those failures in real time so administrative staff can address them to ensure charges are not missed or left unresolved.

“Reliability science shows us that any process has to have a fail-safe to identify and mitigate oversights. Charge Note Reconciliation is that fail-safe. It shows practice leaders and teams which charges have been missed to ensure they capture 100 percent of charges,” says Jason Stein, MD, Co-Founder and Chief Medical Officer, Ingenious Med. “​​If your process relies on each provider being perfect in capturing every charge, which is what many practices are currently doing, you can expect several missed charges per provider per month. That represents significant revenue loss every year.”

Consider: Even a 95% success rate on the first try can be problematic if there is not a fail-safe in place to capture charges on the unsuccessful 5% that can lead to the increasingly common problem of revenue drift or erode profitability.

How the new Document Viewing capability makes capturing charges easier

Regardless of which EMR a provider uses, Document Viewing places the clinical note adjacent to the date of expected service, where it can be read, audited, or attached to the claim. The underlying clinical note then serves as the source of truth to inform RCM staff about what happened during the patient encounter and how to bill for it, which is information that staff would otherwise have to mine by taking extra time to access it within the electronic medical record.

“Charge Note Reconciliation improves the reliability of capturing every charge and Document Viewing makes it easier and quicker to identify missing charges and conduct the primary document review,” Stein adds.

Ingenious Med Charge Note Reconciliation and Document Viewing screenshot

In addition to removing the need for non-clinical staff to authenticate into the EMR, Document Viewing also streamlines RCM for the broader organization because it eliminates the need for practices to constantly grant revenue cycle administrators credentials to access the EMR — which is particularly burdensome for practices that provide care inside multiple systems with different EMRs.

With an HL7 Medical Note Management (MDM) feed, Ingenious Med can essentially conduct precise search and retrieval to extract a specific subtype of HL7 data, in this case the clinical note, as opposed to overwhelming back office administrators with all the data in the EMR, such as lab data, bloodwork, and x-ray reports.

”The combination of our web and mobile tools, ease-of-use, robust security, smart reporting, Charge Note Reconciliation, and now the ability to have document feeds from the EMR all come together to really serve revenue cycle workflows, we can ensure the back office staff get information right from the clinical note,” says Phillip Cone, Technical Account Manager, Ingenious Med. “Additional important benefits of centralizing all those RCM processes are cost-savings and capturing more revenue.”

Case in point: One multi-facility medical group that served as a beta site for the Ingenious Med tools found that its physicians were able to resolve 39% more of their own missing charges, while RCM staff resolved the remainder of the missing charges. In total, the ability to resolve all missing charges translates to a revenue uplift of approximately $5,000 per provider per year for that practice.

Laying the foundation for automated charge capture

Leveraging an industry standard HL7 MDM standard feed not only makes integrating with multiple EHRs simpler and faster, but it also opens doors to accelerate further innovations in revenue cycle management.

“Existing and new clients will be able to harness the high-reliability power of Charge Note Reconciliation and Document Viewing to easily implement and capitalize on the next generation of automated intelligent charge capture when those capabilities become available in the near future,” Stein says.

To learn how Ingenious Med’s technologies greatly improve charge capture rates, schedule a demo today.