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CPI Experts - Services

Charge Capture Audit

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After more than two generations of diminishing reimbursement schemes, many hospitals don’t know what more can be done to preserve or enhance net revenue. The fact is that most hospitals are sitting on a large percentage of legitimate revenue opportunity and don’t know it. These opportunities come from a closer understanding of medical necessity rules, better documentation, accurate system interfaces, and overlooked details of coding and compliance regulations.

CPI Experts is helping hospitals to expose revenue opportunities that are lost through the intricacies of today’s complex environment. Our Charge Capture Audit is designed to evaluate how and where your hospital can improve its net revenue by tightening the many “handshakes” that occur between ordering patient care activities and dropping a bill. By retracing actual patient charts and bills through the system, we help to identify systematic errors that often result in thousands of dollars of lost charges.

Lost Charges

Costly procedures ordered but not charged resulting in around $50,000 of lost charges: arterial blood gases, insertion of PICC catheters, dialysis, cardiac catheterization, implantation of pacemaker

Undocumented Charges

Medical record documentation determines allowable charges: multiple dialysis procedures charged but documentation supported only a single procedure

Incorrect Charge Structures

Charge master should support compliant bundling and unbundling practices:

  • ‘Urinalysis with microscopy’ and similar surcharge items are disallowed; separate charge items recommended for more elaborate procedures.
  • Surgery and recovery room time increments inconsistent with billing practices resulting in gross overcharges; procedure times billed must match clinical documentation

UB vs. Detailed Bill

Thirty-eight percent of charts reviewed have different charges between the UB and the detailed bill.

 

Charge Capture Audit is a review of 50 inpatient and 50 outpatient charts and bills during which CPI Experts will validate that patient bills accurately reflect the care received and represent compliant charging and coding practices. CPI Experts will scrutinize medical record documentation, assignment of codes and modifiers, systems interfaces, and remittance advice notices. As a result, the hospital will identify incidents of systematic error, training or knowledge deficiencies among staff, lost charges, and compliance risks that may threaten the hospital’s bottom line.

Shouldn’t your hospital collect every dollar to which it is entitled? In just three to four weeks, CPI Experts will help your hospital find the revenue it deserves. More information >