U.S. hospitals were already under pressure as a result of healthcare reform legislation and reduced reimbursements. Now declining patient volume is pushing hospitals toward the boiling point. Under these conditions, it’s more important than ever for hospitals to capture all of their charges and receive the revenue to which they are entitled.
Faced with growing budget deficits as a result of these pressures, hospital executives across the country are implementing, or at least considering, cost-cutting measures such as reducing services to their communities and laying off staff members.
But focusing on outpatient charge capture can help executives increase net revenue quickly so that more extreme cost cutting might not be necessary.
Even some of the most prestigious hospitals and health systems experience significant loss of charges, particularly within outpatient areas of service – in fact, we have found lost outpatient charge rates as high as 20 percent to 25 percent in some clinical departments.
Many healthcare organizations look for ways to improve outpatient net revenue by adopting a single solution, such as charge master assessments, claims sample assessments, or charge master and bill editor tools. Although all of these solutions are necessary for the general health of the revenue cycle of hospitals, by themselves they fail to fully identify opportunities to systematically improve net revenue from outpatient charge capture. Relying on these “one-off” solutions often creates performance gaps, resulting in limited return on investment and only short-term improvement.
For comprehensive and lasting improvement, a hospital needs to establish a structured outpatient charge capture program that will focus on identifying longer-term net revenue improvement opportunities and sustainable results. This “revenue integrity” focus should include:
Detecting net revenue leakage quickly using process improvements enabled by applied technology. Today’s technology facilitates a more effective automated approach. Improving clinical department charge capture processes that drive outpatient reimbursements. Making changes at the department level – where services are delivered, documented and submitted for billing – is essential. Supporting existing revenue management staff and prioritizing a focus on significant charge capture initiatives. Limited resources and the complexities of “big data” demand that the organization’s charge integrity staff focus on initiatives that have the most potential to increase revenue. Creating a formal mechanism for accountability and compliance. Every organization needs a structure that holds staff accountable for achieving quantifiable results. Using technology as monitoring tools to facilitate and sustain results. A systematic technology solution for tracking and monitoring results is vital for keeping initiatives on track and the staff focused.An outpatient charge capture program can yield greater and more sustainable improvements than a one-off solution can. As a result, hospital executives will have more options than implementing drastic cost cuts.