If you do not have an internal charge capture audit program, you could be leaving money on the table or inviting an external audit. But with the right tools, you can gain this functionality without impacting workflows.
While charge capture has become more automated, its effectiveness depends on physicians adapting to processes they may find tedious. Automated charge capture helps healthcare organizations account for all services provided to patients, although capturing accurate and complete charges continues to challenge many organizations. A 2017 report from the Advisory Board Company found that the average 350-bed hospital misses $22 million in revenue capture opportunities. When charges are unrecognized or undercoded, it’s as if the services provided never took place – because they were never billed.
Overcoding can also be costly, triggering external audits by the Centers for Medicare & Medicaid Services (CMS) or another payer organization. According to an Ingenious Med survey, close to 60 percent of healthcare organizations have faced at least one audit.
Is your charge capture system putting your organization at risk?
Organizations with multiple EHRs and those with geographically diverse operations are at particularly high risk of being audited. Hospital systems and physician groups that employ a variety of providers across multiple facilities also fall into this category.
In one case, the Office of Inspector General (OIG) required the University of Wisconsin Hospital and Clinics to refund $2.4 million in erroneous bills to Medicare. In another, the OIG determined that New York-based Mount Sinai Hospital owed the government nearly $42 million for improperly billed Medicare claims.
Successful healthcare organizations proactively identify and correct discrepancies that could lead to an audit. This is where the internal charge capture audit comes into play.
Simplifying internal audits
The OIG recommends an internal audit of 10 visit notes per provider per year to ensure accurate coding. An internal charge capture audit is not as onerous as it sounds. It simply requires charge capture tools that can fully monitor performance across the enterprise with a comprehensive data set and sufficient parameters to make informed comparisons. The tool should make it easy to compare any metric at any site or level of your organization, enabling leadership to fully understand the forces shaping the organization without hiring outside data analysts.
Ingenious Med has developed a suite of tools that help clinicians spend more time caring for patients without neglecting charge capture. Our solution is intuitive and easy to implement, extending the reach of your EHR and providing real-time insights and capabilities. This helps organizations standardize performance and enhance revenues from the practice level down to individual providers. It is readily available at the point of care, which reduces the burden on physicians while improving accuracy.
Ingenious Med reporting includes RVU count, patient team assignments, volume, utilization, coding and more. Armed with this knowledge, administrators can measure and benchmark performance to better understand the underlying causes of trends. By examining evaluation and management codes by history, physical examination, discharge, progress notes or by the provider’s total RVUs, the administrator charged with the internal charge capture audit can focus on particular physicians, rather than the entire pool. Until clinicians are made aware of where errors are occurring, they can’t improve.
Incentivizing performance and building trust
When physicians compare their performance to others in their practice, they can share best practices with colleagues and are incentivized to achieve better results. Transparent performance metrics and benchmarking also build trust among team members and help them understand and meet the organization’s goals.
For example, look at Scripps Health, a San Diego-based integrated health system with five hospitals, 19 outpatient facilities, and over 3,000 physicians. For more than a decade, it has relied on Ingenious Med to capture more revenue, deliver actionable productivity and performance insights and more. “Ingenious Med enabled us to measure the exact productivity impact every day by monitoring the accuracy of encounters per provider and other metrics to indicate when we needed to staff up or down,” said a senior executive with Scripps.
Does your organization have a well-defined charge capture audit program? Do you:
- Capture charges within 24 hours?
- Send bills within three days?
- Have less than 1 percent of your charges undercoded or overcoded?
- Have a denial rate of less than 3 percent?
Results like these are achievable. Don’t wait for an OIG audit to find out there’s a problem with your charge capture and billing. To learn more about improving your charge capture and conducting internal audits, contact an Ingenious Med representative at 770.799.0909 or visit ingeniousmed.com/demo.