Healthcare system financial success depends on the ability to generate revenue through effective charge capture—as much as one percent of net charges are lost because of charge integrity issues. One integrated health system with annual net operating revenues of more than $4B wanted to improve its charge capture performance, but the vendor and aging technology the organization had been using to ensure revenue integrity were not meeting its needs. Charge capture performance was no longer improving, and the organization knew it likely had missed charges, late charges, and late coding. However, its patient accounting system and charge capture tool couldn’t provide the insight required to identify improvement opportunities. The organization needed a modern charge integrity solution to help its teams identify inefficiencies and lost revenue from poor charge capture while also ensuring compliance.
To improve revenue cycle performance, the organization replaced its charge capture tool with VitalIntegrity™, an analytics application that enables hospital systems to improve the charge capture process. The organization uses the analytics application to perform daily reviews of all inpatient and outpatient itemized charges. By leveraging the comprehensive rule engine in the analytics application, the organization identifies gaps in charge capture processes and compliance issues, including inaccurate or incomplete documentation, missed charges, and overcharges. These issues, identified by the analytics application, populate a work queue for specialists within the EMR. The charge capture specialists review and reconcile issues, ensuring the ability to appropriately charge for the services provided before the bill is submitted for payment.
Rather than only using the data as drivers for the work queue, the organization evaluates charge capture issues over time, refining the rule engine and leveraging professional services to address root causes to prevent future issues and improve efficiency. Examples of addressing root cause, and the benefits from making improvements include:
VitalIntegrity has improved the organization’s charge capture accuracy and helped advance the organizational ability to ensure all services are accounted for and billed appropriately. In just one year, the organization has achieved:
“VitalIntegrity has improved our charge capture accuracy, increasing revenue and decreasing denial rates.”Chief Revenue Officer
The organization will continue to address root cause issues, and make enhancements to improve the accuracy and efficiency of its charge capture efforts, ensuring revenue integrity and optimal revenue cycle performance.