With over half of hospitals in the US facing the risk of closure and many operating in the red, one might wonder if there is something they can do about it.
Rural hospitals suffer from weak revenue cycles, with many still in the red. But one way to prevent this is through charge capture optimization.
Charge capture is the process that ensures all billable charges are appropriately billed based on what’s performed and optimally charged. Bill scrubbing and charge capture have helped identify missed revenue opportunities and prevent denials from happening.
Continue reading to discover how charge capture optimization helps hospitals and healthcare facilities find critical revenue they might otherwise miss.
Helps With Revenue Lifts
Charge capture ensures all billable services are recorded based on the service provided and helps ensure the hospital is reimbursed appropriately based on payer contracts.
Charge capture is ripe for errors and often an audit can uncover untapped revenue. When analyzing hospitals across the board for revenue opportunities, about 80% of rural hospitals and healthcare providers miss this. It signifies a major deficiency and ultimately a major challenge for hospitals of all sizes.
Rural hospitals often aren’t equipped to handle the technology needed, and even with audits and analysis, many charges still get missed. Coding also plays a role in this, and if hospitals don’t take note, they then miss transactions, including technical and professional fees.
Charge capture optimization helps you find at least 3% more patient revenues, sometimes even more. Most people aren’t experienced enough to notice charge capture errors.
Finding those errors could make or break the company for small hospitals, offering vital profits that might otherwise be skirted under. Revenue lifts can save hospitals, and charge capture optimization utilizes technology to make sure that everything’s caught before the final bill is sent to the patient.
Ensures Outpatient Claims Are Accounted For
Due to the limits of rural hospitals, many are stretched for resources. Outpatient services are complex, and properly optimizing to ensure that all services are billed through complex algorithms will help make sure nothing skirts under the rug.
Charge capture is designed to look for areas of missed charges. If not implemented correctly, hospitals can miss up to 42% of services on their outpatient claims. Due to the complexity, involving an auditor to review can help determine whether a service is reimbursable, and any updates that need to be made, and identify missed charges.
Charge capture is a major problem, but rural hospitals can ensure that those aren’t missed with the right technology. Even those that don’t miss reimbursable service still found over 6% of their outpatient services left in most cases.
Some outpatient claims don’t even go out, and usually, about 1% of patient revenue is missing. If $100 million of patient claims go out, about a million is missing. It would be up to 3% of the revenue in some cases.
Leakage is a major hole in hospitals, especially rural hospitals, and many don’t go back to change this so that with payer contracts, they get the money for the rendered.
Provides Evidence For Negotiating Payer Contracts
Many rural hospitals struggle with renegotiating payer contracts and assume that nothing will change. It’s a major challenge, and if you have fee-scheduled-based systems, it’s hard to negotiate an increase in reimbursement.
Charge capture optimization helps you see everything that’s being charged helps you negotiate it, improve it, and send it out with the right billable amount.
Most rural hospitals struggle with optimizing charge capture because of their EHR. While it’s designed to handle scrubbing and assessing claims, they’re not there to maximize the charge capture. For rural hospitals to get the most out of their EHR, they must leverage it, utilizing algorithms.
Not every charge capture will provide new revenue, rather fixing compliant issues.
The right charge capture will help a business utilize technology and capture all algorithm problems.
Picks Up What Human Audits Don’t
Some claims audits performed by staff don’t pick up everything. When utilized like this, charge capture software will reduce the missed rates of claims.
Charge capture software utilizes resources that fix this problem and also saves money. Audits are expensive, especially when people are involved. Even if it’s 6% of revenue missed, that’s still quite a bit, and it helps find different billable reimbursable services.
Claims done through humans tend to be a waste of time and energy, and when using charge capture software, you can handle these complex algorithms within a system, finding all of the charge capture opportunities. Some organizations miss some vital parts of transactions.
Transfusions, for example, often miss the billing for blood that’s transfused, the administration fee, or other equipment fees.
While just one service, this compounds over time. If the hospital performs anesthesia services, for example, there’s a professional fee, a technical fee, missed billing fees for the anesthesia itself, and so much more. Post-recovery charges are another hole, including charges for coming out of anesthesia.
These fees, when not properly taken into account, oftentimes get overlooked—the same with different codes used for services.
With charge capture optimization software, you’ll be able to monitor every transaction, so you can reduce lost transactions captured and, in turn, net profits.
Charge capture offers a failsafe system that, if it’s missed, you can fix and then update it later before the missed charges creep up and the rates increase.
Utilize Charge Capture Optimization
Charge capture is vital for rural hospitals. Due to the lack of personnel and training, oftentimes, even with EHR technology, some charges get swept under the rug. Properly optimizing charge capture reduces the error rate up to 95% for rural hospitals, providing a failsafe system you can rely on.
Request a demo to find out how you can optimize your charge captures and prevent your business from falling in the red due to missed charges.
