Are you a master of charge capture? One healthcare organization lost more than $2 million annually because its chargemaster was out of date. In another, the radiation department system was not integrated to the hospital system, resulting in half the charges being erroneously dropped

Healthcare Financial Management, March, 2005 by Bruce Morgan, Jim Brown

* Pharmaceutical charges where the dosage levels appear incorrect based on billing requirements

* Blood product charges with no transfusion charge

* Chemotherapy drug charges without administration charges

* Missing companion codes for cardiology and interventional radiology charges, such as Dopplers, stress tests, echocardiograms. and angiographies

* Procedures missing current Medicare "pass-through" items

Requisition/clinical/revenue links. Linking the cost accounting, clinical, and billing systems represents a great opportunity to improve efficiency and data integrity. As an example, clinicians often input information via electronic health records when service is provided. However, the billing information goes through the charge capture system and the patient clinical information is cap lured in the medical records system. Separate staffs support each function, even though much of the information required is the same. Today, many vendors are embedding patient coding information into the electronic health record system. Establishing a link between the two can enhance compliance, reduce costs, and improve revenue recognition.

Revenue management dashboards. Empowering departments with information is perhaps the most effective way to manage charge integrity. Often, departments fed disengaged from the revenue management process. Today, providers are creating department specific dashboards that provide 'real time" information on errors or omissions that may have occurred. Although the statistics will vary by clinical specially, dashboard metrics may include detailed information on registration errors, discharged not billed coding errors, and charge omissions, to name a few. Establishing a departmental dashboard has proven effective in conveying critical information while gaining departmental buy-in.

Other innovative technologies. Technology and tools to enhance revenue management are evolving and improving every day. While large clinical information system vendors are attempting to develop the "complete" package, other boutique players are focusing on targeted solutions. An example is the "'digital pen," by which clinical notes are captured electronically and directly interfaced into the targeted system. These types of technology eliminate redundancy and improve accuracy because the clinical documentation also serves as the basis for the billable event.

Strategic Pricing

In an era of increased governmental and public scrutiny, hospitals need to be able to support their charge structure--that is, they need a strong basis for the prices they charge and they should be able to explain how those prices are derived.

Before hospitals evaluate their charge structures. however, they need to understand their costs. Although many providers use cost estimates to establish an initial price for a new service, chargemasters are filled with charges that were established many years ago and inflated through annual price increases. Additionally, these costs were frequently based on aggregated cost information and did not accurately reflect the true cost of the service. In today's cost accounting environment, detailed costing is much more reliable.