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Revenue Leakage: 3 Methods to Revive your Charge Integrity Program | HIT Consultant

Certain practices can help ensure that health care providers realize the full benefits of a robust charge integrity program to safeguard compliance and to optimize results.

Three proven methods exist to build a successful charge integrity program:

1. Conduct Routine Audits

The first step is to evaluate where your current charge integrity program stands. Comprehensive charge capture, cost recovery and defensible pricing are essential elements for today’s health care organization to thrive. Understanding best practice processes is also key for success.

The CDM data drives the entire revenue cycle. Without an accurate, complete and defensible chargemaster, an effective charge integrity program will suffer. Audit your chargemaster to ensure it facilitates accurate, comprehensive billing in accordance with regulatory guidelines. Do not settle for the status quo; conduct chart audits of patient encounters to validate documentation and assess the current charge capture workflows established to discover potential shortcomings.

Implement a defensible price strategy that is transparent and relative to cost. As price transparency grows, so does the need for compliance and accuracy. Patients are becoming savvy consumers now that they are required to pay a larger share of the cost due to higher deductible plans. Access to simplified and accurate health care pricing is critical since health care consumers may use this information to make informed decisions on where they receive care. Publishing list prices is a strong first step, but health care providers must ensure that their charges relate to the cost of providing the service. Though it is a good idea to compare pricing in your market, CMS pricing benchmarks could be 18-24 months old and are limited to items hard-coded with a CPT®/HCPCS. Thus, it is wise to consider more recent proprietary pricing benchmarks that a vendor partner can provide.

Develop a daily charge capture reconciliation process to ensure an accurate, compliant and clean claim. Conducting manual spot checks is a good way to start, but ideally health care providers should proactively review and reconcile 100% of the line item bills for key service lines prior to claim submission.

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Revenue Leakage: 3 Methods to Revive your Charge Integrity Program.

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