Charge Capture Checklist

Through our work with critical access hospitals and other medical facilities, we have identified several areas where charge capture may be an issue. Below are checklist items for providers to review to ensure that charges are being captured and revenue realized. Charge capture is a patient-specific process, and it can be dependent on payer-specific guidelines.

#1 

Perform a random audit of an itemized bill and Medical record of the claim submitted and identify the charges that were not captured.

#2

If the technical portion is charged, should there be a charge for the professional component as well? For example, EKG reads (93010) are commonly overlooked when the EKG recording (93005) is billed.

#3

Are there items in the chargemaster that are no charge that should be chargeable items?

#4

Hourly billing of observation: Recommend auditing the bill to ensure that all hours of the stay are accounted for.

#5

Review the descriptions in the chargemaster for accuracy, as CPT/HCPCS codes and their descriptions may change over time. Charge Description Master (CDM) narratives should be reviewed at least annually to ensure they accurately describe the service being delivered. Pharmacy services are often one of the biggest offenders of this. Payers require the use of HCPCS codes, and often the chargemaster description does not match the HCPCS description. This may result in incorrect reimbursement when units are misreported. The descriptions should be clear to both clinicians and patients.

#6

Inaccurate mapping of revenue code to CPT/HCPCS code can result in inappropriate payment or denials.

#7

Make any retired charge items inactive (not deleted) so they cannot be routinely used. Obsolete or invalid charge items impact both the inaccuracy and size of the CDM. These lines often contribute to manual business office manipulation of any claim that contains an obsolete charge.

#8

Inconsistent pricing across departments for similar services: While there may be reasons for pricing differences for similarly coded services across departments of an organization, payers have taken note of this and, in some cases, are pursuing an audit of these services. Is there a policy in place for pricing differences? For example, ER service or treatment room.

#9

Is there a policy in place for making changes to the chargemaster, and does this include sign-offs from the department and facility management?

#10

We recommend automating the charge capture process wherever possible.

Questions? Contact us today or learn more about our healthcare accounting and consulting services!