Closing Gaps in Your Revenue Cycle

Apr 05, 2017 at 08:08 pm by Staff

Charge capture should be one of the easier aspects of managing your practice's revenue. Right? A provider submits a charge for services rendered, and the charge is captured and billed for reimbursement. However, if there is a lack of policy and procedure applied to this essential component of a healthy revenue cycle, practices can lose out in revenue--big time.


A busy surgeon felt he was working day and night, yet his income was lower than ever. Further research showed he was not reporting his surgeries to the coding department, which meant he was losing out on reimbursement for dozens of surgeries. He wasn't actually doing less--he just wasn't reporting the work he was doing. An interview with the coding department revealed that the department only knew if an unscheduled surgery was performed if the doctor reported it. Takeaway: Don't make charge capture dependent on physician reporting. A busy doctor has many priorities, namely patient care, that take precedence over administrative reporting.


Charge capture errors aren't always due to a lack of reporting; sometimes it's exactly the opposite--charges are reported for something that was never done. Nothing invokes patient dissatisfaction like charging them for services they did not receive. In today's busy world, it's easy to get ahead of ourselves by documenting before the services are rendered. Takeaway: Avoid "pre-loading" of services. Do not assume that the service was rendered before the service was rendered.

Example: A patient is presenting to the clinic for a routine and repeat injection, so the medical assistant enters the injection charge based on that preliminary knowledge. During the brief exam, the doctor notices that the patient has severe flu-like symptoms and decides against the injection. The patient's insurance plan gets billed for a procedure that never happened, and the patient receives a bill. This can lead to patient mistrust, complaints and reporting to insurance companies what is, in essence, a fraudulent claim--not to mention the administrative cost to correct the error.

Check for correct reporting

Ancillary services, such as labs, drugs and supplies, are a big target for missed revenue opportunities. Make sure your charge master is updated regularly to include all services and supplies performed in your practice and to educate all staff on the importance of proper reporting. The number of units in drugs administered is often an area of concern that can cost thousands of dollars if not reviewed and maintained regularly. It is crucial to identify every step of the charge capture, from the point of service to the payment of the service.

Example: One practice audited was billing one unit of an injectable (100 units) but injecting 10,000 units. It was losing the revenue of 99 additional units of the drug on each patient, equaling about $1,150 per error. "We really didn't read the HCPCS manual, we thought one injection equaled one unit," the practice's coding department says. This is a very common error. Many practices do not match their services to descriptors in the HCPCS manual, causing costly misreporting. Takeaway: Verify all ancillary services in your charge master to ensure charge per unit and that the number of units are being reported.


It is crucial to identify every step of the charge capture, from the point of service to the payment of the service. There is no "one-size-fits-all" answer to this common problem. But creating a step-by-step walk-through of your charge capture that includes all places of service (office, hospitals, physical therapy departments, nursing homes); all ancillary services (drugs, labs, X-rays, supplies); and all services (surgeries, minor procedures), as well as creating a policy for each area that can be monitored and reconciled regularly, is key to accurate charge capture.

Easy first steps can include making sure every test, x-ray or visit is ordered through your EHR and then reconciling charges to those orders. For hospital surgeries, accessing the hospital's operating room (OR) report for your providers regularly can reveal missing charges reconciled against the OR log. As you map out your processes, make sure you review them regularly to close all the gaps in your charge capture process. Prevent charge lag by requiring that all charges be submitted within a specified time frame and adhere to it. The longer a charge is uncaptured, the higher chance it has of being incorrect.

Whether your charge capture process is done via an intelligent charge capture app, an EHR or a sticky note, it is important to have a formal process in place to avoid improper or inaccurate charge capture.

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