Improving Charge Capture

Losing Hospital Revenue?

Check the Charge Capture Drain.

It isn’t a secret in the healthcare world that hospitals operate on razor-thin margins. The easiest way to increase revenue?  Get paid for the work you’re already doing. As much as 1% of net charges are lost due to charge integrity leakage, according to a 2017 study published by the Healthcare Financial Management Association.

Tracing the Source of Charge Capture Leakage: Paper Documentation

It happens more often than you might think. 

Even as you read this, crucial patient care notes are likely floating around the floors on paper rounding lists, fated to never enter the EHR. 

This is because EHRs, although a valuable tool for healthcare billing functions, are not optimized for clinical workflows. Clinicians are forced to perform a lot of their work on paper, jotting down diagnoses and patient-care tasks that never make it back into the hospital’s EHR. 

The outcome? Key revenue opportunities are lost on paper. 

Error-Prone, Incomplete Clinical Documentation

Human memory is naturally error-prone. Notes jotted down early in a clinical shift are susceptible to being misplaced in the chaos of the next 8 or 12 hours. (And it’s estimated that 7.5% of paper documentation is lost completely.) By the time the clinician is transcribing notes for the EHR, some things just won’t be top of mind anymore. 

 Patient conditions that lead to urgent situations – for example, chest pain that ultimately becomes a heart attack – are far more likely to be documented correctly in all the right places. 

 But what if that episode of chest pain turns out to be heartburn? It’s likely that details of care won’t stand out in the clinician’s mind enough by shift’s end. What isn’t remembered won’t be transcribed in the right place at the end of his or her shift. 

 Inaccurate or incomplete documentation affects charge capture in a few important ways:

  • Services and treatment provided aren’t billed
  • Patient co-morbidities, symptoms, and clinical interventions may get left out of the EHR, negatively affecting CMI and reimbursement
  • Billing is delayed while CDI teams wait for physicians to respond to coding queries

Paper Documentation and CMI

CMI, which measures the acuity of a hospital’s patient population, directly affects CMS reimbursement. The higher the complexity of care and resources provided, the higher your CMI (and reimbursement) will be.

Incomplete documentation that doesn’t capture all the nuances of care provided results in an inaccurate picture of CMI – in other words, it can appear that low-acuity patients are experiencing excessive morbidity, mortality and length-of-stay. Or that high-acuity patients aren’t receiving the appropriate level of care.

Paper-based clinical workflows risk omitting documentation of key information that could increase CMI. For example, a physician might run a test, and that gets documented and noted in the electronic chart. Good! But the test results and subsequent interventions don’t make it into the EHR. Not good.

Paper Documentation and Severity of Illness 

Insurers and regulators look at severity of illness to determine the value and quality of care, expecting outcomes to match the care that gets documented. 

Documentation that doesn’t accurately represent the severity of patients’ conditions compared with mortality rates can result in a red flag that threatens reimbursement. 

This is an especially worrisome problem for hospitals that receive high numbers of patient transfers. Incomplete documentation of a patient’s condition upon arrival can paint a false picture of excessive morbidity and mortality. So the hospital is “fixing” these patients – but not receiving full credit, in a sense (i.e., proper reimbursement).

So How Can We Plug the Charge Capture Drain?

It starts with better clinician documentation. Hospitals that have carefully investigated charge capture leakage consistently find that improving clinician documentation is one of the most effective ways to increase CMI for optimized billing. 

Give Clinicians the Right Tool to Support Documentation

CareAlign, a clinician-designed app built to reduce preventable errors and improve charge capture, addresses the biggest “leak” in the charge capture drain: paper documentation. 

Digitally Capture Diagnoses at Risk of Being Lost on Paper

A digital workspace accessible from any mobile device, CareAlign replaces paper in clinical workflows. It enables clinicians to record patient assessment and care plan notes in one place – on the fly, at the point of care. The app integrates with any EHR, ensuring more complete capture of revenue opportunities.

With CareAlign, clinicians digitally document diagnoses that otherwise are at risk of being lost on paper lists.

When clinicians can get out from under the paper burden, great things happen: increased patient safety, improved patient and clinician satisfaction … and optimized billing.

In fact, users report that CareAlign cuts their documentation time in half.

CareAlign Can Increase Billing by How Much?

At a large, academic health system with a fully functioning CDI team, CareAlign increased billing by $480 per admission through improved CMI – translating to millions in additional revenue.

Let’s break down the math behind that increase:

12 months pre-CareAlign: CMI = 1.35

12 months post-CareAlign: CMI= 1.41

Using the CMS base multiplier of $8,000, that .06 increase in CMI translates to $480 billing increase per admission.

Here’s a closer look at how CareAlign helps hospitals better capitalize on revenue opportunities by reducing paperwork and increasing CMI: 

Streamline Documentation and Reduce Errors. CareAlign stays with clinicians throughout their entire shifts, providing one place to document care. By the end of their shifts, clinicians have accurate, minute-to-minute documentation at their fingertips. It eliminates the redundant, error-prone work of relying on memory and transcribing patient care notes multiple times in multiple places.

Standardize Clinician Notes with Best Practice Bundles. With best practice bundles incorporated in the app, CareAlign brings decision support to the point of care. These bundles not only help clinicians provide safe, effective patient care in line with evidence-based guidelines, they also recommend appropriate documentation. 

Reduce Time to Billing. Earlier chart completion equates to faster payment, minimizing the time between patient discharge and billing. 

Help CDI Teams Work Smarter and Faster. It’s true that hospitals with a CDI team in place are already optimizing billing. But CDI specialists can only question and optimize the documentation that makes it into the EHR. Because CareAlign helps providers capture more clinical notes and standardizes the way they write them, your CDI team has much better quality documentation to work with – and fewer physician queries to wait for. 

Beyond Billing

CareAlign users report the following additional benefits:

  • 75% of users report errors prevented in their practice
  • 80% of users report improved efficiency
  • 81% of users report earlier decision-making

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