A healthcare organization’s revenue cycle can quickly become chaotic if there aren’t proper practices put in place to maintain it. The charge reconciliation process is a necessity because it allows fast and accurate charge capture and resolution of any pending charges. Because of how extensive a hospital’s revenue system can be, this means charge reconciliation must happen daily.
The issue here is that with archaic systems that haven’t been updated at many healthcare organizations, staff still will often have to take up to several hours per day to generate and review reports for each patient that has visited. This means that inaccuracy is practically a given and hospitals will have revenue leakage constantly.
How Can Charge Capture Reconciliation Fix the Problem?
Having a daily charge capture reconciliation process allows a healthcare organization to bridge the gap between them and providers, leaving little room for error in revenue movement. With the correct software and staff training put into place, a new reconciliation process will allow users to monitor all revenue that’s deposited into a specific healthcare organization. The process will be able to identify any discrepancies quickly, that all payments are posted successfully, and that all insurance documents are reconciled.
Ultimately, having a new reconciliation process results in an increase in hospital productivity, client satisfaction, and an increase in revenue. Staff won’t have to take time out of their busy days to interpret report information so the system can do its work while they take care of all the hard tasks. A new system’s automation process is also so quick and exact, that healthcare organizations can now have ample time to fix cases and gain ownership of charges back in specific departments.
For example, if a hospital uses a specific anesthesia provider and doesn’t have anyone on staff that can keep 100% accurate documentation all the time, they are most likely breaking compliance and are sending either too much or too little funding back. This can cause all parties to lose revenue and more time to have to go back and fix case issues that could have been better handled by a concise reconciliation process.
Can we Trust Automation?
The short answer is yes, healthcare organizations can trust automated systems and should be moving their processes more in the modern direction, but it takes proper training to get everything down. A common misinterpretation of an automated system is that it can do everything without any direction. Any new software used has to be given directions of what to look for and what to generate in its reports.
The common problem that arises is without a knowledgeable staff that has been trained in the software and knows what to look for in the case of discrepancies, mismanagement will happen. This can deem the process as ineffective when in reality, specific users that have been trained to use the software need to be the ones who audit the system.
For example, the experienced users would need to program the system in a way that helps them identify any insurance inquiries or inaccurate billing that could lead them to be non-compliant with their state’s government. They would have to enter in specified data including name, dates, and more to ensure the process can gather information correctly.
Roles of People Involved
The individuals who handle any new charge capture reconciliation software will be skilled in both the clinical department and financial. These users have in-depth knowledge of what a specific hospital handles, and how their revenue flows throughout any given day. It’s extremely important to find staff that can fully utilize everything a new process has to offer because technological benefits can quickly get lost with untrained eyes.
What are the Consequences of Not Investing in it?
Chasing around paper trails all day instead of investing in a proper charge reconciliation process can have a severe impact on a healthcare organization’s system. Many of them who have tried to use “universal” approaches are equivalent to staff who have not made any changes at all. These employees don’t have the bandwidth to analyze the information as often as they should, and they aren’t as meticulous as they should be. This has resulted in many organizations finding that they have around 25% claim rejections overall.
All of this can lead to overcharging and undercharging. With overcharging, hospitals are automatically dinged as being non-compliant, which leads to more expensive costs and lost revenue that must be reimbursed to the payer. For example, if the government in a specific state was a payer, and a hospital used was found to be overcharging, that authority can legally charge and add on additional penalties, fines, and more.
Undercharging means that hospitals aren’t being paid sufficiently for their services. That revenue that’s missed can’t go back into the hospital’s system as a future investment towards other systematic changes or labor.