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“Recovery Auditors identified $3.75 billion in improper payments, with $3.65 billion related to overpayments and $102.4 million to underpayments.”
Charge Capture Errors: What can go wrong?
“There are lots of places where something can go wrong with your hospital bill. By our count, 289 of them.”
The hospital billing process has never been more complex. From preregistration to surgery to discharge and until the bill is paid, the opportunities for errors compound as doctors, nurses, and other caretakers, as well as administrative staff, all influence the final bill. This article discusses this process and what can go wrong along the way.
“The credit rating agency Equifax found in an audit that hospital bills totaling more than $10,000 contained an average error of $1,300.”
$12 billion annual savings through claims automation and significant medical billing error rates persist
The American Medical Association finds that $12 billion annually, or 21 percent of total administrative costs, can be saved by automated claims management systems. Other key findings include:
- Commercial health insurers make errors on over 7 percent of paid medical claims
- Medical claim denials decrease
- Claim scrubbing edit transparency increases
“Of the claims the government investigated, NerdWallet found that 49% of the Medicare medical claims contain medical billing errors.”
Reclaiming Lost Charges
Increasing charge capture efficiency is often an area of concern for hospital and health system administrators. This is understandable with up to 3 or 4 percent of revenue lost to missed charges. In this article, suggestions for tackling charge capture improvement are outlined and the case is made that resulting revenue gains overshadow the inherent challenges of process improvement.
9 Medical Billing Errors That Enrage Patients
Charge capture is a critical component of claims management. Knowing what can and cant go on the bill as well as which charge code combinations work and which cause problems is essential. Getting it wrong can mean denials and upset patients. This education topic covers 9 common medical billing errors and what you should watch for.
“Without faulting either side, Stephen Parente, a professor of health finance and insurance at the University of Minnesota, said his research on medical bills found that up to 40 percent of claim statements passed between insurers and hospitals have errors.”
Revenue Cycle Exchange: Making Every Penny Count
“Of the 32 leaders who responded to a pre-event survey, half cited insufficient integration and collaboration between finance and clinical teams as the biggest barrier to revenue cycle improvements.”
Increasing collaboration and cooperation between a hospitals financial and clinical worlds is essential to revenue cycle improvements. Engagement from all areas is critical to increase charge capture and effectively manage denials. The following topics are among those discussed in this article:
- Integration of financial and clinical systems
- Up-front insurance verifications
- Use of technology to catch errors and track denials
- Patient-friendly staff and culture
5 Tips Towards Finding Missing Revenue
“Of the 32 leaders who responded to a pre-event survey, half cited insufficient integration and collaboration between finance and clinical teams as the biggest barrier to revenue cycle improvements.”
According to a consultant with 30 years of experience in healthcare, there are many opportunities to find missing revenue in hospitals. The following are suggested areas to start looking:
- Review charge description master (CDM)
- Review outside lab services
- Review drug testing codes
- Review extended time capture codes
- Review physical item charge codes