Charge Capture And Charge Entry Services For US Practices
With UControl Billing, every encounter that is recorded becomes a posted charge, gets reconciled against the schedule, and is ready to be coded within your own system. We expose those charges that your reports cannot detect before it is too late.
Native within your EHR/PM system
HIPPA-compliant, BAA signed
One team from capture to coding to billing
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Charge Capture Is The First Revenue Cycle Step To Fix
A denial dashboard is leadership’s view of payer friction in its totality. It isn’t. If a charge goes uncaptured, there will be no denial, rejection, or exception report. As such, the dashboard will remain green despite the fact that the money will have been lost. This problem is structural in nature because a missed charge does not create a transactional trace for billing software to identify. When charge lag is added to the situation, charge lag being the gap between the date of service and the date the charge is captured, two processes occur simultaneously. On one hand, details are forgotten while on the other hand, the claim approaches its deadline. For Medicare, the deadline is one year after the date of service under 42 CFR 424.44. Past that time, the claim will be rejected as untimely and, according to CMS, there will be no possibility to appeal that decision.
What Is Charge Capture In Medical Billing?
Charge capture is the revenue cycle process by which all services provided that can be billed are entered as charges within the billing system to ensure nothing is left unbilled.UControl Billing is responsible for managing charge capture and charge entry services for US practices in the comprehensive revenue cycle management services we offer, filling the gap between what you do and what you get paid for.
Charge capture is the point at which revenue integrity starts, the seam where the clinical service becomes the financial transaction. It takes place at the point of service or immediately following, using the note, procedure log, and supplies used to create a charge out of each documented service. There are two words that go hand in hand here and cannot be used interchangeably. Charge capture is the broader concept and contains the point-of-service meaning. Charge entry is the individual act of entering a documented service into the billing/practice management system.
Each charge is then compared with the chargemaster, which is basically the master list containing the association between each service and the appropriate charge code or fee schedule. It is important for us to do this since clinical practice develops at a much faster pace than the underlying coding and pricing process. There may be instances when a device or technology is introduced in a procedure but does not reflect in the chargemaster, resulting in an undervalued charge. Charge capture doesn’t determine the code used in a certain procedure.
How The Charge Capture Process Works, Stage By Stage
There are five steps required to transform the service performed into a chargeable service. We sit in the middle of that chain and ensure that the clean, complete charges get passed down the line to coding and billing.
Service performed
The provider meets the patient and provides a service to him or her, from an office visit to a bedside service.
Service documented
That service is documented in some form, which can be notes, superbill, encounter sheet, or an automated charge in the EHR.
Charge posted
Each of those documented services is put into the billing/PM system and validated against the encounter.
Charge reconciled
We reconcile each scheduled patient who met the provider to make sure there are no missing charges.
Charge cleared down the line
Clean charges are passed on to coding, then to billing.
Types Of Charge Capture: Manual, Electronic, Mobile, And Outsourcey
Where charges are captured determines where they will be lost. Each of the four capture techniques varies in terms of speed, effort, and how much of the load remains with the clinicians.
Outsourcing service
The third-party billing company handles the entire process of capturing, posting, and reconciling charges.
Manual
Superbills or encounter sheets completed manually, followed by data entry. Low entry barrier, but the time between patient care and entry is precisely the point at which details and charges are lost.
Electronic (EHR)
The generation of charges from within the EHR as part of the process of completing the note. More efficient and fast, but gaps arise in situations where there is inadequate documentation or where posted charges are not reviewed against the schedule.
Mobile/Point-of-Care
Applications that allow clinicians to post charges outside the office, whether out on rounds or in the operating room. Best suited for situations where the charge originates some distance away from the billing department.
Charge Capture Vs An Outsourced Service
The line is drawn at who takes responsibility for the task. The software gives you the means to perform the task and puts the actual task of capturing, posting, and reconciliation on the shoulders of employees who are busy all day long. The outsourcing service UControl takes care of the task and guarantees its success. The software solution is best for those practices that wish to manage the process from within the practice itself. The outsourcing service is perfect for those practices that do not wish to have the charge capture process managed by their employees permanently.
Charge Capture Vs Medical Coding Vs Medical Billing
Search engines blur these three steps, as do many other billing departments. They happen in succession, and they rely on each other, but they are separate actions, and this separation decides whom to blame when revenues are missing.
| Step | What it does | What it produces |
|---|---|---|
| Charge capture & entry | Confirms a billable event happened and records it as a charge in the system | A charge on the patient account |
| Medical coding | Assigns the standardized codes to the captured service | A coded, claim-ready charge |
| Medical billing | Submits the claim to the payer and works it to payment | A paid (or denied) claim |
The reason why the line is needed: the coder is able to do no more than what has been captured, meaning that a small charge becomes a small code becomes a small claim. In reverse order, if the mistake is done and codes are applied to the documents where there is no evidence for them, under-capturing becomes a compliance risk. Capturing correctly first is the prerequisite for proper coding and billing, not something extra. UControl captures, codes, and bills, but here we are talking about the former: posting and reconciling the charge to make sure it is not missed further.
Common Charge Capture Errors And Their Revenue Impact
Every leak has a cause. It is simple enough to identify the lost revenue line. Why it was lost and what the cost is for having it disappear down the line is the way you find out what to do to prevent it.
| Charge Capture Error | Revenue Impact |
|---|---|
| Missed and dropped charges | The clinician completes an encounter and begins on the next patient before the charge is created. The encounter took place and was generally documented; however, there was no charge created for it. Since no charge was created, there is nothing to be rejected by billing, leaving it invisible as a denial. The problem is that there was no claim created because there was no charge to start, so therefore, no revenue generated. |
| Charge lag | The greater the gap between service and charge posting, the less detail there will be and the closer you get to approaching your filing deadline. Best practices post within 24 to 48 hours; the current HFMA benchmark is below 5 days. Post any later and you extend your days in accounts receivable before the payer has ever seen the claim, risking an untimely-filing denial. |
| Supplies, implants, and bill-only items | An implant will be implanted in the operating room and cath lab without any matching charge being entered. Bill-only and consigned supplies frequently dodge normal charge capture, meaning the expense is incurred without a revenue charge ever being captured. It is in fact because of their soft nature that such charges lie outside the chargemaster and thus leak silently at a high monetary value per occurrence. |
| Multi-location and rounding leaks | If charges are generated anywhere but at the desk, on the floor, across multiple locations, then charge capture relies on the memory of the physician for capturing them. Ancillary departments such as therapy, lab, and imaging maintain their individual documentation. If these are not communicated back to the billing department, then the charges disappear. |
Benefits Of Accurate Charge Capture For Your Practice
Audit-ready documentation
Proper documentation of the charge and the claim ensures audit-ready documentation for a payer or internal review, whereas a rework would be required if there had been no proper documentation in place beforehand.
Faster cash to you
Posting charges in a day or two will result in faster claims processing, driving the days in AR down at the root. Cash that used to wait in the pipeline gets deposited in your bank account on schedule you can predict.
No denials further downstream
Clean and validated charges mean better data for coders and proper claims for billers. Denial prevented at the point of capture means the staff doesn’t waste their time dealing with it later.
Complete, justified reimbursement
Each service provided gets turned into charges, and what gets billed matches what was done. You get full credit for all the services provided without overcoding or undercoding.
Decision-making based on accurate data
Accurate financial metrics enable leaders to make decisions on them; they will not be forced to ask their denial management team to pursue underpayments due to the problem of non-capture of high-margin cases.
Our Charge Capture And Charge Entry Services
Four integrated tasks completed by the same staff that bills, codes, and collects on behalf of your practice. One standard, one single point of contact
Charge posting
Services rendered recorded into your billing or PM system quickly and correctly, each one checked against the visit in real-time. Postings continue with such precision that lag never sets back the AR clock from the start.
Charge reconciliation
Each visit and appointment matched up against the corresponding posted charge so no patient scheduled and seen falls between the cracks. This process operates as an entire-day volume control, not a random check done after the day is over.
Charge gap and lag auditing
The charge not made, identified; the time from service to claim, minimized. The audit digs upstream from billing and into the period when a missing charge can still be recovered before it is too late.
Multi-site, rounding and facility charge capture
For multisite practices, hospitalist practices, and ASCs, where charges originated away from the desk and thus escape most easily, capture is built into the off-site workflow
Where Charge Capture Fits In The Revenue Cycle
Charge Capture
Due to the fact that healthcare revenue cycle processes are interconnected, an error made at this point cannot remain unnoticed. A charge that is entered late becomes uncollectible days in the accounts receivable cycle.
A charge that is entered partially appears again as a denial that must be addressed through an effective denial management process.
Late Charges
Delayed entries reduce revenue collection speed and increase A/R days.Incomplete Charges
Missing information creates billing errors and payment delays.Denial Prevention
Accurate capture helps reduce avoidable claim denials.Charge Capture By Practice Type And Specialty
Search engines blur these three steps, as do many other billing departments. They happen in succession, and they rely on each other, but they are separate actions, and this separation decides whom to blame when revenues are missing.
| Charge Capture By Practice | Charge Capture By Type | Specialty |
|---|---|---|
| High volume primary and urgent care | With many visits occurring each day, even a low percentage error becomes substantial quickly, simply because of the volume. Volume itself is the risk | Volume leak |
| Hospitalists and rounding doctors | The charges originate far away from billing on the ward and are recorded only after the rounds end. It’s all about memory and timing. | Remote capture leak |
| ASC and surgical | Implant and supply consumption and bill-only items take place in the room, but not always through the capture process. | Supply and implant leak |
| Multisite organizations | Every site operates differently and has its own processes. Without an agreed-upon capture process across all sites, it’s consistency that suffers. | Consistency leak |
EHR and Practice Management Systems We Work In
UControl is a billing service, not a software firm, so there is nothing to buy and nothing to migrate. They work within the existing system used by the practice, meaning there will be no need for any data migrations, no need to train the front office to use a new interface, and no forced platform lock-in to link billing to the vendor’s product line. Other billing companies offer their practice management software to route the billing through it; they require practices to change an existing software just to solve a billing issue. UControl solves billing issues using the existing tools.
How Much Charge Capture Services Cost
There is no single price, because the cost follows the shape of your practice. Here’s what makes it tick, and the pricing models that you’ll see out there in the marketplace.
- Number of encounters: More charges to bill and reconcile on a monthly basis.
- Number of sites: Each additional site means an additional site to reconcile.
- Complexity of your specialty: Surgery and procedure work have more charges to enter.
- Degree of reconciliation: Simple posting versus thorough audit with lag recovery.
- Configuration of your EHR: How your software is setup to get charges.
- Collection of off-site charges: Rounding and facility charges have more tracking involved.
HIPAA Compliance And Charge Accuracy In Charge Capture
A touch to your charge data is a touch to PHI as well as influences what the payer sees. It takes both halves into consideration
| HIPAA Compliance | Charge Accuracy |
|---|---|
| The Trust | The charge data is PHI, hence the engagement is covered by HIPAA regulations and has a completed Business Associate Agreement before any access is granted. Access follows the minimum necessary rule and every charge operation is recorded for audit purposes. The data does not leave your system; we work inside of it under your control. |
| The Accuracy | Over-coding is another risk inherent to the inaccurate capturing of the data. Over-coding and under-coding both attract payer's attention, and a trend becomes a serious problem if there is a pattern even when there is no fraudulent intent at all. We capture the charge data according to what the record supports and update the data in accordance with CMS National Correct Coding Initiative edits so the charge stands up to review. The code decisions are left to coding, but the charge decision should match the performance. Please see our Billing Audit Service. |
How To Get Started With Outsourced Charge Capture
Discovered & free audit
We perform an audit of your present-day capture process against the timeline and provide a free audit that uncovers how charges are escaping and how much it's costing you.
EHR & standard process integration
We set it up to work in your current environment and align your capture and reconciliation processes with how you operate.
Live capture process with oversight
Your capture and posting process goes live with an oversight team tracking your lag, reconciliation, and recovered charges
Why Choose Ucontrol For Charge Capture And Charge Entry
The team responsible for capturing and posting your charges is the team that codes those charges, bills those charges, works denials, and produces results. This is what makes the difference between a vendor and a revenue cycle.
One standard, end to end
From capture, to coding, to billing, to recovery, everything is governed by one compliance standard. The charge goes through the same rule across the board.
Seamless process, no room to get lost
With individual vendors handling each step separately, your charges simply fall between the cracks. Full ownership eliminates all those cracks.
Full view of the situation
Since your denials and A/R go through us too, we are able to see where the gaps in your capture processes are costing you and how to fix those that earn you money.
Medical Billing Certifications and Compliance Standards
We hold the certifications that payers and auditors look for, and our coders carry the right credentials. It’s not the most exciting part of the work, but it’s the part that keeps your claims on solid ground.
Explore Frequently Asked Questions
Charge capture is a process through which every billable service, procedure, and supplies used during the patient encounter are captured and recorded as charges in the billing system. Charge capture occurs at the point or just after the point of care and utilizes clinical documentation as the source of information. It is the first step in the revenue cycle since an unbilled service will not be captured, coded, or billed.
Charge capture is the broad process of recognizing that a billable service has been provided and documenting the service. It is the term given to the point-of-care activity. Charge entry is the step where the billable services that have been documented are keyed into the billing or practice management software.
No. Capture of charges indicates when a billable service took place and documents that service as a charge. Coding is the process by which those charges are assigned standard codes. Both processes are related and sequential but separate since coders have no input on capture and need all their charges documented before they can do any coding. Finally, billing occurs after coding and involves submission of the coded claim to the payer.
Charge lag refers to the time period between the date of service and the date of entry of the charge into the billing system. Two important considerations apply to charge lags. Memory is not good at holding details, so charges may be either missed or poorly documented. In addition, each day of lag is an extra day of days in AR before even being seen by the payer and getting one day closer to the timely filing deadline. The best practice is less than 24 to 48 hours.
A non-captured charge will not generate any denial, any rejection, or any exception report since nothing has been inputted into the billing system to alert. The service has been provided, the cost incurred, but there was no revenue generated. This is a small problem, multiplied by many occurrences, resulting in big loss. The HFMA estimates that on average an average practice loses $125,000 per year due to missed charges, while hospitals lose one percent of their net patient revenue.
Yes. The outsourced process takes care of capturing, entering, and reconciliation in your practice using your existing EHR/PM system. The difference between outsourcing and software is simple – with software, you have your people doing the job, with a service such as UControl, it is UControl’s people doing it and owning the outcome.
No fixed rate. It varies with the volume of your encounters, the number of facilities, the difficulty of specialties, the level of reconciliation, and EHR integration. The usual pricing models include per charge, percentage of collections, or flat monthly rate. You will receive an offer that considers your particular practice after a free charge capture audit, so it will be priced right next to your losses.
We operate on the platforms that you are already using, such as athenahealth, eClinicalWorks, Epic, Tebra (Kareo), NextGen, AdvancedMD, etc. We do the charge capture within your system, so you have nothing to learn and nothing to migrate.