The Evolution of Charge Capture Technology

On the surface, "charge capture" seems simple enough: A provider documents the service provided (the procedure) and the reason why (patient diagnosis). But there is much more complexity that governs the process. At the heart of it all are the thousands of numeric (and soon to be alpha-numeric) procedure and diagnosis codes that can change annually when new codes are introduced and others are retired. Then there are the rules, a countless number of rules that fall under an alphabet soup of categories (e.g. CCI, NCD, LCD) that are dependent on a variety of factors including payer type, geographic location, and provider specialty. If a submitted charge violates just one rule, payment will be denied until the error is corrected and the claim is re-submitted. The process of working a denial can be time consuming and resource intensive; for some practices it just is not worth the effort if a relatively low dollar amount is at stake.

The comfort of paper

Until recently, the most common vessel of charge capture was the paper encounter form -  a document that would need to make its way to the business office for counting, data entry, and filing. Even today with the majority of doctors sitting at a workstation during a visit or using a smartphone, there are still those that prefer paper over technology, or perhaps have no other choice, in the private practice and hospital alike.

The reality is that physicians are extremely pressed for time. With reimbursement cuts continuously looming and more patients entering the system for care, the pressures on physician practices are only accelerating. Any physician would rather have more face time with a patient then spend time on administrative work, and what is easier than circling a few codes on a piece of paper? Unfortunately, paper cannot reflect all of the complexity behind the charge capture process, and at the end of the day it is the physician that is legally liable for accurate and compliant charge capture, not the individual hired to perform data entry. There is tremendous scrutiny of physician charges to ensure overpayment did not occur; should an audit reveal a pattern of overcharging, there are significant financial and legal ramifications.

A need is met

In the late 1990s when personal digital assistant (PDA) devices were hitting the consumer market, there was recognition that mobile technology could do a very efficient job at managing information that was otherwise stored on paper. Increasingly these devices were adopted for their ability to electronically present calendars, contact information, e-mails and so forth. It did not take long for physicians to appreciate the hardware's value in delivering information where it was needed - at the point-of-care, close to the patient interaction. The smaller PDA form factor made it easy to store in the white coat pocket, and a variety of applications provided real-time decision support around medication dosing and clinical best practices. The PDA also suited electronic charge capture as well, replacing the encounter form with an application that went where the doctor went, presenting lists of patients to be seen, and digital forms of the myriad compliance rules that charges must adhere to.

As physician adoption of mobile charge capture started to accelerate, a number of financial benefits materialized, regardless of technology vendor or clinical specialty. For example, missing charges dramatically decreased. Charge tickets were easily lost, or just never completed. Clinical end-users were also exposed to a wider universe of procedure codes than could be accommodated by one sheet of paper, so the charge value of a patient encounter increased. And since charges could be electronically transmitted with a higher degree of accuracy given embedded coding rules, payment was received faster, decreasing the number of days in accounts receivable.

A lot has changed in the last decade since mobile charge capture started to gain momentum. Most notably, the presence of office-based electronic records systems. While these tools were developed to manage clinical work flow, they were also capable of recording a charge using an on-screen version of the paper super bill. And as office care tends to be more straightforward in nature than hospital care, an EHR can handle charge management effectively: one appointment, one charge. But when a provider leaves the four walls of the practice to round on a hospitalized patient, often times the EHR is not accessible and providers still find themselves writing on a piece of paper.

Meeting expectations

So how does using charge capture technology , affect a physician's practice? Ideally this is a time-neutral switch from paper which means that any software must be intuitive to the physician with a limited number of clicks and taps. The technology must have the flexibility and configurability to fit within a physician's daily work flow, which can vary greatly from provider to provider. Some physicians like to see a patient and then immediately enter a charge, which is a best practice; others prefer to sit down at a workstation and complete charge capture at the end of the day. Provider preference is often based on the number and complexity of patients seen, location and availability of an EHR and internet access. 

When it comes to system expectations, given that charge capture sits in the center of the revenue cycle, demonstrable financial benefit remains a top priority. A conservative estimate of financial impact is a one-time cash acceleration opportunity of about $10,000 (from reducing the days that payment is outstanding) and ongoing annual revenue increase of approximately $25,000 per provider. Physician users of this technology also achieve greater insight into their billing patterns, especially compared to their peers. This can be especially valuable when examining physician productivity or intensity of services provided.

As smartphone technology has advanced, and with 80 percent of today's physicians using such a device in their practice, according to the Wolter Kluwer Health 2013 Physician Outlook Survey, charge capture solutions have evolved accordingly, supporting a number of tasks falling outside of pure charge documentation. One example is aiding the process of cross coverage so that physicians can easily cover for one another and access relevant patient history for appropriate decision making. For inpatient providers especially, face time with colleagues can be limited, and the ability to digitally review information documented by other caregivers can be immensely helpful.

Many of the available technologies also leverage native smartphone functionality, including the ability to call or securely message a peer from within the application to communicate pertinent patient information that isn't necessarily something that needs to be documented in a clinical system. And with incredible pressure around the protection of personal health information, providers wishing to rapidly communicate with a peer are wise to do so using technology that is secure via encryption.

Ryan Secan, MD, is the chief medical officer for MedAptus, a provider of healthcare revenue cycle solutions for achieving effective charge management, compliance, and work flow efficiency. Secan is a practicing hospitalist at Emerson Hospital in Concord, Mass., is board-certified in internal medicine, and a member of the American College of Physicians and the Society of Hospital Medicine. E-mail him here.