Charge Capture Analytics Enables $7.8M Revenue Increase

CHARGE CAPTURE EFFECTIVENESS VITAL FOR SUCCESS

Healthcare system financial success depends on the ability to generate revenue through effective charge capture—as much as one percent of net charges are lost because of charge integrity issues. One integrated health system with annual net operating revenues of more than $4B wanted to improve its charge capture performance, but the vendor and aging technology the organization had been using to ensure revenue integrity were not meeting its needs. Charge capture performance was no longer improving, and the organization knew it likely had missed charges, late charges, and late coding. However, its patient accounting system and charge capture tool couldn’t provide the insight required to identify improvement opportunities. The organization needed a modern charge integrity solution to help its teams identify inefficiencies and lost revenue from poor charge capture while also ensuring compliance.

ANALYTICS IMPROVES REVENUE CYCLE PERFORMANCE

To improve revenue cycle performance, the organization replaced its charge capture tool with VitalIntegrity™, an analytics application that enables hospital systems to improve the charge capture process. The organization uses the analytics application to perform daily reviews of all inpatient and outpatient itemized charges. By leveraging the comprehensive rule engine in the analytics application, the organization identifies gaps in charge capture processes and compliance issues, including inaccurate or incomplete documentation, missed charges, and overcharges. These issues, identified by the analytics application, populate a work queue for specialists within the EMR. The charge capture specialists review and reconcile issues, ensuring the ability to appropriately charge for the services provided before the bill is submitted for payment.

Rather than only using the data as drivers for the work queue, the organization evaluates charge capture issues over time, refining the rule engine and leveraging professional services to address root causes to prevent future issues and improve efficiency. Examples of addressing root cause, and the benefits from making improvements include:

• The analytics application identified charges for injections and infusions in the outpatient surgery setting that did not have a corresponding charge for surgery or procedure. Data exploration resulted in the development, implementation, and refinement of a rule to identify outpatient surgeries and procedures that were missing coding and charges for a surgery or procedure, recovery, anesthesia, and/or supplies.
• The organization had been using a list of 30 different key performance indicators for billing. After evaluating the indicators in relation to charge capture processes, it substantially narrowed the number of billing indicators.
• 这是该组织第一次能够在编码完成之前识别要支付的账单。该组织调整了其时间表，使编码员有足够的机会在提交账单前完成编码。
• The organization also has new insight into late charges and late coding and can evaluate the impact of any registration or changes on charges, identifying new opportunities to reconcile and close cases.

RESULTS

VitalIntegrity has improved the organization’s charge capture accuracy and helped advance the organizational ability to ensure all services are accounted for and billed appropriately. In just one year, the organization has achieved:

• 每年增加780万美元的收入，这是提高收费捕获准确性的结果，并基于所提供的服务。收费完整性分析解决方案确定了超过23K个独特的帐户，以进行审查和改进。在安装的前45天内，VitalIntegrity识别出的漏电次数是之前电荷捕获工具的1.5倍。
• Automation and efficiency improvements enabled the organization to expand its revenue cycle charge capture improvement efforts to an acquired hospital—without adding additional resources.

“VitalIntegrity has improved our charge capture accuracy, increasing revenue and decreasing denial rates.”

Chief Revenue Officer

WHAT’S NEXT

该组织将继续解决根本原因问题，并作出改进，以提高其收费捕获工作的准确性和效率，确保收入的完整性和最佳的收入周期表现。

ADDITIONAL READING

• Charge Integrity Analytics Improves Revenue Recognition, Retaining More Than $6M
• Accelerate Charge Capture Improvement with Health Catalyst VitalIntegrity™
• Amplify Your Organization’s Revenue Opportunities: Introducing Health Catalyst VitalIntegrity™
• Vitalware® by Health Catalyst
• Health Catalyst Announces Agreement to Acquire Vitalware, a Revenue Workflow Optimization and Analytics SaaS Technology Solution