Charge Capture Risk-based Solutions & Revenue Cycle

Charge Capture Risk-based Solutions & Revenue Cycle

Opportunity

Financial success for many healthcare organizations is dependent upon accurately capturing and charging for eligible services and supplies. Failures in the charge capture process jeopardize revenues and patient satisfaction, as well as regulatory compliance. Delays in posting charges may result in increased rework and reconciliation on the back end, while failing to capture charges may mean missed revenues altogether. The 2007 Healthcare Financial Management Association (HFMA) study* of 30,000 complete medical records and comprehensive billing and collection records across more than 100 hospitals showed, on average, that healthcare organizations were losing 1 percent of revenue to errors in the chargemaster or charge capture processes. Protiviti can help healthcare organizations evaluate controls and implement improvements to the critical charge capture process.

Insight

Protiviti’s charge capture services help organizations quantify and identify root causes of inaccurate charging and resolve them permanently. A sound, well-executed charge capture process, focused on both quick wins and long-term improvement, will ultimately lead to the desired result: enhanced profitability. Our approach properly considers and balances business processes, revenue operations, technologies and compliance-affected areas to help organizations achieve long-term results and sustainable improvements. Our approach utilizes Protiviti’s Charge Capture Control Framework to provide a baseline for identifying process risks, developing process controls and enhancing key charge capture processes that, if implemented, will lead to a reduction in charging and billing errors.

This approach also assesses revenue processes and systems from a holistic business process perspective. The results then can be leveraged throughout your organization to standardize controls.

Impact

Protiviti’s charge capture services are aimed at improving and streamlining processes, thereby enabling organizations to enhance profitability, reduce compliance risks and improve patient satisfaction. As an added benefit, a successful improvement effort should help increase collaboration between departments and lay the groundwork for implementing a successful charge capture program which:

  • Emphasizes the equal importance of administrative responsibilities and patient care
  • Ensures that all services rendered are captured and posted timely, accurately and completely
  • Includes the performance of overall monitoring to ensure that policies and procedures are followed consistently
  • Establishes accountability for assigned responsibilities
  • Provides performance feedback to individuals, thus increasing accountability
  • Facilitates effective implementation of new pricing or charging methodologies
  • Provides an opportunity to substantially improve revenues and margins

Contacts

If you would like to learn more about our Revenue Risk Solutions or contact one of our practice leaders, please visit www.protiviti.com/healthcare or call 866.721.8340.

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