When physicians are not in the exam room or the OR, they are documenting patient encounters and filling out heaps of paperwork. For many surgical practices, the methods of record keeping — 3×5 inch index cards, colorful sticky notes, and paper checklists — are not only inefficient, they are not HIPAA compliant and lead to a great deal of billing blunders.
Keep reading to learn why charge capture has a major impact on the bottom line and how to successfully improve charge capture for your surgical practice.
The result of these rigid old-school methods? Two hundred and sixty-two billion dollars in lost revenue each year. And the larger the practice, the greater the potential loss. If a few codes slip through the cracks in a small practice, it’s problematic and frustrating. If this happens repeatedly at a large practice, it can be crippling.
What is Charge Capture?
Charge capture is the process of compiling all the information necessary for health providers to get paid for their services. Physicians, clinicians, and billers work together to collect all the details and data required to file a medical claim for surgery.
SurgiApp Helps Improve Charge Capture for Surgical Practices
SurgiApp is a HIPAA-compliant mobile app that allows all medical staff to record patient details in a synchronized platform. Surgeons, billers, schedulers, and equipment reps all have access to the same information and can log relevant information, making recording charges accurate and efficient.
With Surgimate’s app, billers are able to easily track the status of patients and their medical information, leaving less room for error when processing charges.
Benefits of an Automated Charge Capture Process
For such a complicated process, it is mind-boggling that many facilities continue to rely on manually recording information without a digital system. Adding technology to the system is helpful since automating processes can drastically curtail errors, and strengthen the quality of submitted claims.
But, incorporating more systems to automate the claims and billing process is only part of the equation. Many EHR systems offer plug-ins or add-on tools to assist with billing and coding for clinical visits, but capturing surgical charges is more complex and not supported.
The answer to such medical claim debacles? Introduce a prescribed, tech-driven workflow that makes it clear to every department and individual involved exactly what they need to do at each stage in the process.
Fallouts of Inefficient Charge Capture Processes in Surgical Practices
Reimbursement
There are many opportunities for claims to be delayed or denied, such as:
- Filing a surgical code not authorized by insurance
- Reporting an inaccurate charge description
- Skipping a modifier
- Submitting past the time limit
These all result in missed revenue, deferred payments, and costly reworking. Whether it’s regular charges, add-on codes, or consults, when services go unbilled, claims are denied and reimbursements are underpaid, the financial health of a practice can be threatened.
According to the American Academy of Family Physicians, the medical claim denial rate is 5-10%. For many surgical practices, receiving a claim denial is a regular occurrence.
While 90% of denials are avoidable, only 66% are recoverable. Denied claims cost, on average, $118 per claim to recover the money lost. Practices that have high rates of denied claims, such as 35%, could cost up to $20 billion in delayed or lost reimbursement.
It is crucial for practices to set up a system that can significantly lower the chances of error.
Reconciliation
Even if billing staff receive notification (whether it be on paper or electronically) of charges that need to be captured, ensuring these charges are actually processed is another step that often happens manually.
Staff either go into the appointment scheduler and manually mark off the surgeries that the MDs have submitted for, or keep a paper list that they literally check off with a pen. With each item checked off valued in the thousands of dollars, this method seems more rudimentary than remunerating.
Regulatory Compliance
HIPAA is not the only compliance framework medical practices must worry about. There is also the False Claims Act, the Clinical Laboratory Improvement Amendments, the Stark Law, and others.
Overseeing everything is The Office of Inspector General (OIG), which has strict rules for how medical institutions must comply with such policies.
Medical billing compliance is designed to prevent fraud. And just like fraud in any industry, this crime can carry a hefty fine.
The OIG and Department of Health will audit any practice they suspect of upcoding –adding extra tests or procedures — or downcoding — intentionally leaving out tests or procedures.
Internal audits should be included in a charge capture workflow within the surgical practice to ensure compliance and prevent costly errors.
Steps to Improve Charge Capture in Surgical Practices
1. Standardize Operational Procedures and Policies
The first step to improving the charge capture process is to institute a prescribed workflow, starting from the time the patient arrives until the medical claim is submitted.
Every department should be involved — from surgeons to schedulers to billers. Protocols should be well documented, and employees should be well-trained regarding their individual tasks and the bigger picture.
2. Internal Auditing
With the hectic nature of medical practice, it’s no surprise that items on paperwork can get checked off incorrectly, charges reported twice by different staff members, and old prescriptions find their way onto new bills.
To avoid such mistakes and improve billing accuracy, practices should build quality assurance checks into their workflow. Adding a system of periodic internal auditing for departments and staff involved in the charge capture process will reduce the likelihood of errors and punitive fines
3. Leverage IT
Adopting an EHR system can improve charge capture by increasing the number of mean charges per patient by 7%. For the average-sized medical practice, this translates to thousands of dollars in extra revenue per month.
However, many EHR systems do not have portals specifically designed to automate the surgical charge capture process and collaborate with other departments.
Introducing new technology or plug-ins that integrate with your practice’s existing EHR is worth the investment.
Surgimate’s mobile application allows surgeons to quickly and easily capture their surgical charges from any mobile device. This includes:
- Confirming authorized CPT codes actually performed.
- Adding additional CPT codes not authorized (to alert billing/pre-cert to retro-authorize). When this is completed in a timely manner, retro-authorization won’t be necessary and it eliminates the chance of denial.
- Confirming and adjusting billing modifiers as necessary.
- Capturing consults and on-calls to ensure they are billed.
The data can automatically be synced with your billing system to ensure all codes are accounted for and billed.
4. Enjoy The Payoff
With medical charge capture apps, such as SurgiApp, facilities can efficiently streamline the charge capture processes flow in surgical practices. This enables practices to enhance profitability and communication across departments.
Creating standard procedures, and conducting internal audits will ensure a decline in claim denials, fewer compliance issues, and improved patient satisfaction. No less importantly, it will save your medical practice thousands of dollars a year.
