Charge Capture and Chargemaster Optimization: Where Revenue Gets Lost
- Micro-Dyn
- Mar 12
- 3 min read
Healthcare providers perform countless billable services every day. Behind the scenes, these billable services must travel a path from point of care, through charge capture, into the hospital's charge master, and finally becoming a clean claim. This path is full of opportunities for revenue to disappear. Any seemingly small amount of revenue leakage can multiply over time, resulting in millions of dollars lost.
💡 What is Charge Capture?
Charge capture is the process by which hospitals record billable services. This includes procedures, supplies, and medications delivered to patients. Charge capture feeds into the hospital's billing system, and reimbursement depends on its timeliness and accuracy.
📋 What is Chargemaster Management?
The hospital's chargemaster is its database where services are recorded and mapped to codes. The chargemaster lists the services, their prices, departments, codes, and applicable modifiers. While department numbers are unique to providers, CPCT/HCPCS and revenue codes are more standardized. HCPCS codes are updated by the Centers for Medicare and Medicaid services, or CMS. A hospital's chargemaster is everchanging. As drugs, codes, and regulations change, so must chargemaster management. The chargemaster, or CDM, is the backbone of every healthcare organization's revenue cycle.
⚠️ Revenue Leakage with Poor Charge Capture and Chargemaster Management
Chargemaster management and charge capture are rife with potential revenue loss and compliance risks. Let's review some of the most common issues:
Services are performed, but slip past being entered for billing. This is most common in departments like the ICU where clinical staff are busy with care and lack the time for proper focus on documentation.
Services are captured, but mapped incorrectly to CDM line items. This can cause undercoding, overcoding, or claim denial. This is often because coding is entered before CDM is upgraded.
Services are coded and captured, but the coding used is outdated. When retired CPT or HCPCS codes are still used in the CDM, revenue can easily be lost. With such consistent IPPS, DRG, and APC updates, keeping a CDM accurate can be tricky.
Services are coded to incorrect revenue codes. This is a common cause of claim rejection, but some coding software is designed to flag it.
Services aren't coded to the correct departments. This can occur when more than one department is involved in services, causing miscommunications in the charge entry.
Services are coded without correct modifiers. For real revenue integrity, providers need the ability to add multiple codes and modifiers to each item. Lack of modifiers over time can lead to systematic underpayment for the hospital.
These potential problems can all cause incomplete or incorrect documentation. Under-billing or over-billing can both cause issues, leading to lost revenue, claim denials, or audits. Missed charge capture can also delay payments for services rendered as information needs to be resubmitted for processing. As complex as the healthcare revenue cycle is, great software can help your organization streamline it.
⚙️ Improving Charge Capture and ChargeMaster Management with Micro-Dyn
Healthcare revenue integrity is tricky, but it's possible to get chargemaster management right. Your organization can achieve accurate charge capture and prevent revenue leakage with Micro-Dyn. Not convinced? Here are some of the ways Micro-Dyn functions as a revenue integrity solution during the charge capture process:
Reliably Current Codes in Clinical Documentation
Micro-Dyn is reliably current, and created by teams that track payment rule changes across the entire revenue cycle. This means your healthcare system won't lose revenue opportunities with outdated coding. Keeping up with regulatory changes can be tricky, but revenue protection is possible with Micro-Dyn.
DRG and APC Accuracy for Claim Submission
Micro-Dyn's DRGActive and APCActive help ensure that CDM entries are aligned with the correct reimbursement grouping. Micro-Dyn's DRGActive-APR product provides 100% APR-DRG-compliant processing aligned with 3M Corporation specifications, supporting up to 25 ICD-10 diagnosis and procedure codes per claim.
Medicare Code Editor (MCE) Validation
When MCE validation is integrated into your coding software, coding errors are easier to prevent. Micro-Dyn's MCE validation tool helps you avoid common charge capture errors.
Seamless Integration Into Your Charge Capture Process
Micro-Dyn is built to work with your existing workflow and is installed locally. This means they don't retain any data, eliminating any HIPAA risks or concerns. Micro-Dyn's team is genuinely experienced in healthcare claims and understands the health system's revenue cycle.
🔒 Prevent Lost Revenue, Reduce Denials, and Upgrade Your Chargemaster With Micro-Dyn
Lowering denial rates with CDM and charge capture optimization is an obvious win. Helping your health system avoid missed revenue, audits, and denials is just best practice. That's Micro-Dyn's advantage.
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