Tackling charge capture challenges with revenue integrity

Hospitals have several options to consider when attempting to solve misplaced or missing service, product, and medication charges. Many organizations have an order entry system that creates a charge when a product or medication is ordered.

Usually, providers place the order through the patient’s file in the system to properly assign the charge to the patient. However, many patient care areas have what is called floor stock.

Floor stock is a term used to identify inventory items (e.g., bandages, gauze pads, boxes of tissues, water pitchers, tongue depressors, linens, masks, minor instruments) that are used to replenish stock. These materials are kept in a patient care area for employees to use without having to either place an order through the order entry system or issue a requisition.

Some organizations may choose to bundle the costs of these items into their room and board charges, while others may choose to charge for these supplies separately. Regardless of method, however, actually capturing these charges depends on the provider’s workload and conscientiousness in recording when these supplies are used.

In some innovative organizations, the HIM departments take responsibility for capturing charges from departments such as the emergency department, obstetrics, and even the operating room. These departments are similar in that they are high-paced environments with significant amounts of medication used, combined with multiple or complex procedures performed. This means there are plenty of errors in the capture of charges, and as a result, there are a lot of opportunities to reduce lost charges.

Charge capture specialists, who often have coding skills, may work in these departments to perform a variety of duties, including:

• Analyzing contents of reports and software edits to facilitate charge revisions with appropriate departments.
• Analyzing medication administration records to validate that medications charged are consistent with the number of medications administered. Collaborating with the pharmacy and compliance departments on discrepancies.
• Batching claims and fixing batch errors in the system.
• Collaborating with the managed care department to code billable items for reimbursement.
• Ensuring that all charges are received and entered in a timely manner.
• Maintaining reports of charge errors or charge-related issues by service area for management purposes.
• Posting charges for those departments for which HIM performs charge entry.
• Reading the patient record to identify charges not billed and entering those charges. Also identifying charges billed that lack corroborating documentation.
• Receiving and tracking paper charge tickets and/or electronic files for one or more specific revenue locations.
• Reviewing all charges prior to entering them into the system for missing billing requirements, as well as collaborating with appropriate staff to secure information for billable items.
• Reviewing billing edits and claims edits that are associated with charges.
• Reviewing various reports to determine if drugs drop into the patient code summary.
• Utilizing clinical and coding knowledge to resolve billing inconsistencies.

For more information, see The Revenue Integrity Managers’ Guidebook.