So, you have an EHR for charge capture, but are you still manually doing a lot of work to get charges out the door?
These problems might sound familiar:
- Practice managers and administrators feel like they are spending too much time and effort reviewing all the charges associated with the patients in their sub-specialty, cross-referencing to see if there are missing charges, and acting as the first line of defense to make sure charges have the right information before it’s sent to coders
- No easy way to see if there are missing charges for all encounters your providers had. For example, cross-referencing patients seen in an inpatient setting (tracking down every consult and encounter to see if there’s an associated charge) or cross-referencing patient lists with charge reports
- No easy way to see the status of all your charges – which ones can go straight to billing, which needs review, and which ones are stuck in a queue
- Still have to communicate billing issues with clinical staff via email, spreadsheets, post-it notes, and carrier pigeons
- Still have to review every single charge even though they are clean and could have been billed
These are some of the most common problems I hear about when it comes to the charge reconciliation process and bottlenecks in the revenue cycle. Imagine if you had a patient encounter, you capture that charge, and then it goes out straight to get billed. In reality, however, the charge capture and reconciliation process are anything but simple or linear.
If you’ve recently switched from a manual paper and spreadsheets charge capture program to an EHR, you might be wondering why the process hasn’t really gotten any smoother and why you’re still using spreadsheets or emailing staff to get more information on a charge. Or perhaps you used to have a charge capture system but got rid of it when you transitioned to an EHR, thinking you’d have the same functionality.
EHRs are important and necessary tools to use, but when it comes to the overall charge capture and reconciliation process, they’re still just one piece of the puzzle and they don’t solve the charge capture problems you’re experiencing.
In reality, there are gaps in the EHR workflow. Even once you’ve captured charges in your EHR, you still have to analyze them. Your first line of defense is often a practice manager or administrator, who has to review for the basics: are there any missing charges? Did the provider include the right documentation? Is there a diagnosis code? Then they must communicate errors with a provider on the additional information they need – and they have to manually keep track of the providers they’ve reached out to and are waiting for answers from.
Then, the charges may get passed to your coding team. The coders typically have to download a spreadsheet, review every single charge, identify any issues, and then communicate problems to the provider around the missing information. This all happens outside the EHR (which poses another problem, since the charge information can easily contain PHI that isn’t secured).
As the reviewer gets more information from the provider, they might be crossing off a list in their spreadsheet to know it’s corrected, which leads to another problem – there’s no record or visibility of what had to be changed or corrected, and no way to analyze any trends to prevent inefficiencies in the future (I.e., 20% of Dr. Joe’s charges were rejected and needed further documentation). And there’s no easy way to see all your charges at a glance, and key metrics on how many can go straight to billing with no interference.
The bottom line? Even though you submit a charge, it doesn’t mean the charge capture and reconciliation workflow is complete. In fact, it’s usually where the work begins – and where the biggest revenue opportunities lie.
3 biggest challenges of the revenue cycle workflow
These challenges cause three big ramifications on your hospital’s revenue cycle workflow.
1) Missed Charges = Missed Revenue
It’s very common that if coders must review every single charge, and there’s missing documentation, they either have to chase the provider to get more information or change the billing code, and under-code. This causes a lot of lost revenue.
Let’s say a provider submits a charge in the EHR, does their documentation, the coder reviews it, and the documentation doesn’t match what they should’ve charged for. That deficiency needs to be communicated back to the provider. You cannot bill out that level of that code because it doesn’t match the documentation, or the coder would need to down-code the code. Those situations occur all the time. Perhaps you need documentation on how that encounter relates to that charge, or maybe the charge was submitted without a diagnosis code. Then, there are situations where you are not able to bill the entire encounter out, let alone just have it down-coded. The result is a full loss of a charge.
Even when you do reach out to the provider for additional documentation, you then have to wait for the correct information and fix it in a timely manner. If it’s sitting out too long, it will never get paid.
Finally, when it comes to the role of practice managers and administrators, they need to review the profitability of each specialty and how much revenue is coming in. The only way to accurately do this is to make sure there are no missing charges – but the EHR tools aren’t set up to give you this information efficiently.
2) Too much back and forth and miscommunications
Second, since there’s no clear way in an EHR to see a full view of every charge and their status, there’s a lot of back-and-forth communication that goes on, via texts, emails, and more spreadsheets. EHRs don’t have any sort of communication tool that lets you communicate with providers when you need to find missing information.
Prior to using an EHR, you might’ve written down all the information on paper, trying to decipher what a provider wrote, what code it says to bill, if there’s enough specific information to bill for that code, and so on.
Now, with your EHR, you might’ve thought that since everything is captured electronically, you won’t have this missing information. While you may have more information in an electronic system like an EHR, you still might be missing the information you need to get a charge out cleanly. Some things I commonly hear from providers are: I would’ve expected to manage all the charges in one spot. How can I see all the cleanliness of charges and their workflow status in one place? Is there a management-level view of total charges and total revenue opportunities and what we’re missing?
Prior to using an electronic system, it was common for each hospital specialty group to have practice administrators submit all their charge tickets on paper. Then someone enters the data into a system where the charges are reviewed. Now that it’s being done electronically, your goal is to get this all centralized so you can have economies of scale on how you’re capturing revenue instead of doing it differently for each individual department. And along with that centralization is making sure you have a seamless way to rectify all the challenges in the revenue cycle process.
3) No visibility and insights
Let’s take this common example. Each subspecialty practice administrator is responsible for the business operations of their specialty, which includes charges, then it gets sent to their central business office. A practice manager is then responsible for taking all the charges that were inputted into your EHR like Cerner, and then tracking the status of each charge – is it being reviewed by a coder? Was it sent to billing with no issues? Was it denied? This is typically done in a spreadsheet, with updates being made all the time – since there’s no way to do it in real time in Cerner. This is one of the missing pieces of the revenue cycle process that we help solve.
In another example, a Revenue Integrity Specialist who has an EHR like Cerner might’ve thought that they would’ve been able to see a dashboard of all their changes in the EHR, a list of missing charges, a work queue of which charges are clean and can be billed right away and which ones need to be reviewed – but they can’t. There’s no way to learn from the past – such as Dr. Jones’ level 3 charges should always be reviewed because he’s new and the last 2 months required additional documentation.
The missing piece of the revenue management process
As more and more healthcare organizations look to centralize their operations, it’s time to understand the missing gaps and bottlenecks in the traditional charge reconciliation and revenue cycle workflows.
The bottom line: Even though you submitted a charge and have that information electronically in your EHR, that doesn’t mean the whole workflow around charge management and reconciliation has been fixed. There are still too many missed revenue opportunities, convoluted workflows, compliance risks, and labor inefficiencies going on – areas we help solve.
Since we are so well integrated with EHRs like Cerner and Meditech, our charge capture solution helps you standardize how you manage, capture, and reconcile charges directly integrated with your EHR.
Your charges are still created in the EHR but we play the role of managing the process to make sure that you’re not missing charges and revenue and that charges that are clean can go straight to billing. Finally, we help you allocate the right resources to review charges that need to be fixed and give you better insights into the status of every single charge. All those challenges that we talked about at the beginning? We help solve those.
This is a critical missing piece of most healthcare organizations’ revenue management processes – and by helping you solve it, we give you more revenue on the table and more improvements in how you work.
Frustrated with your billing operations?
- Losing revenue from missed charges?
- Still, having to communicate billing issues with clinical staff via email & spreadsheets?
- Using spreadsheets for missing charges because it’s not available to be seen in the EHR?