How do you optimize your charge capture and coding workflows to reduce denials and delays?

In charge protection, best practice would be to reconcile charge capture by report or rules-based alert that compares scheduled visits with charges. An electronic EMR that drops charges is going to be most efficient at this. Rules-based alerts can identify missing companion codes that are typically charged together, but a when encounters are not reconciled to schedules, we run the risk of dropping all charges. Start with a clear policy that outlines the expectation that charges will be reconciled to visits and/or orders. Focus on technically-supported workflows that reconcile contacts to charges and build rules for companion codes, then monitor consistency of code volumes over time to ensure the capture process remains stable.

Denials are increasingly becoming a bigger problem for practices. It is no longer enough to track denial rates but a greater level of detail around the denials. For example, the types of denials by payor, volume, denied procedure codes, modifiers, and overturn rate of appeals denials, among other data points. This information is very valuable to present to a payer to help resolve issues that might be undetected by the payer. This can help get claims paid and also with future contract negotiations with the payer.

Documentation should always reflect what was done during the visit. Particular procedures, such as spinal blocks for pain or MOHS procedures, require specific documentation to show the medical necessity for the procedure. Documentation templates within an EHR can help prompt the physician or non-physician practitioner to document specific elements. For example, a spinal epidural often requires by most Medicare Administrative Contractors (MACs) the pre and post-pain scale of the procedure. Many local coverage decision policies require documentation of failed conservative treatment regimens before the more advanced procedure. Templates help capture that information as required by policy.

Reporting on data is critical to help drive performance and accountability. Carefully consider edits. Edits are useful when applied correctly; however, they can also create work queues that further bog down and delay the revenue cycle process. Edits may be needed for the short term if a system upgrade will cure a known issue and claims need to be stopped or manually adjusted as a stop-gap while waiting on a system upgrade. Edits can also be a crutch and used as a bandaid for a much larger problem. Edits should be closely monitored as they stop the claim from continuing on the adjudication process.

Many RCM-Medical Billing teams rely on traditional, manual methods for charge capture, leading to errors, delays & missed revenue opportunities. They miss out leveraging technology & streamlined workflows to enhance their charge capture processes. This oversight can result in increased denials and revenue leakage. Investing in charge capture solutions including coding assistance, can enhance accuracy & efficiency, reducing the chances of errors. Regular training sessions can empower them to capture charges accurately, reducing the likelihood of denials. By adapting to technology, educating your team, committing to continuous improvement you'll reduce denials and enhance the overall efficiency of your revenue cycle management.

When aligning a chargemaster with payor requirements to ensure charges are populated correctly requires setting rules within the chargemaster. Rules, or business rules, are essentially an "if-then" type of statement. For example, a payor may require a particular HCPCS code instead of a CPT code. The "rule" maps the proper code and/or modifier based on the design of the rule to match the payor policy. This prevents having to create multiple chargemasters. Establishing proper rules helps ensure a clean claim and proper capture of charges.