Closing the Charge-Capture Gap
JoAnn BerkFull charge-capture has become a must for today’s radiology practices. In addition to affording the obvious advantages of improved cash flow and lost-income recovery, full charge-capture offers providers access to a more complete—and therefore, more accurate—complement of data for use in negotiating with hospitals and payors, assessing physician productivity, and formulating staffing decisions. JoAnn Berk, senior vice president of client services for Dominion Medical Management, Inc. (DMM; Milwaukee, Wisconsin), a revenue-cycle–management company, says that technology has significantly enhanced the charge-capture process. However, she notes that potential gaps in data flow—coupled with a tendency, among hospitals, to alter revenue categories or make other changes and about which practitioners are often the last to know—make a strong case for managing the charge-capture process with a system steeped in additional analytics. Berk cites, as an example, a practice that employs 18 radiologists, maintains several freestanding imaging centers, and serves four hospitals. The group was experiencing a high volume of lost charges, and it turned to DMM when its third-party billing company was unable to determine why this was occurring or how to rectify the situation. As it does for all new clients, DMM first determined how the hospitals’ IT departments would identify appropriate files for its use. DMM asked many questions, Berk notes, “to ensure that all possible modalities, contracts, and group reading physicians, including locum tenens, were included. We will often identify potential problems up front and will make sure we get the correct data in our incoming files.” The Data Tools The billing and charge-capture procedures now executed by DMM on the practice’s behalf take into account four data files requested from the hospitals—one each for patient demographics, dictated reports, hospital technical charges, and accession/occurrence logs. Access to data in the latter two files clears a path for identifying radiology charges billed out by the hospital in question. It also allows for a breakdown, by accession-status indicator, of all procedures scheduled or cancelled by radiology departments and subsequently moved through their systems. DMM PRISM proprietary revenue cycle management system correctly correlates these data and generates a report that indicates which procedures were performed on a given date of service, confirming that all have been billed. The system also flags missing demographics and reports for that particular date of service. “Early on in our relationship with a client, we use this information to help hospitals to hone their files and give us a more complete picture, going forward,” Berk notes. DMM has done this for the practice, but as in many cases, it continues to find a small number of missing demographics and reports. Berk observes, “Occasionally, we’ll see situations where we did not receive full date-of-service reports.” She adds that in a growing practice or for a busy charge month, gaps like this might go unnoticed without the additional analytics. Moreover, through a proprietary Document Review Program, DMM communicates with the practice’s physicians about any medical-necessity issues and/or documentation gaps that might arise. Practitioners subsequently access the appropriate patient record and/or images in order to document more completely the need for the procedure performed. Accessing and analyzing a wider swath of data bolstered the practice’s monthly charge capture and cash flow by $95,000 and $25,000 in 2010, respectively, representing a 20% increase on each side. While the group had feared that its income due would decrease as a result of Medicare rate reductions and coding changes executed in 2010, that figure rose by $280,000 over the previous year’s total. Berk emphasizes that this is a viable example of the benefits to be reaped through the use of a good billing and validation system. It effectively demonstrates the value of analytics in achieving full charge capture. Julie Ritzer Ross is editor of