Hospitalist Perspectives: The value of charge capture

Well, there’s been a lot of COVID talk on this blog lately, but I think I’m going to take a break from that this time, and talk a little bit about what originally brought me to work at medaptus ten years ago.  While it doesn’t seem cool and cutting edge (anymore), one of the most critical aspects of keeping a medical practice open and functioning is billing and charge capture.  Regardless of a person’s occupation, when you do work, you should be paid appropriately for the work that is done.  And unfortunately, physicians often do not do a particularly good job with this (even though it may seem like the bills you get for healthcare are outrageous, there are an enormous amount of physician charges that are just never submitted, and therefore never paid).

When medaptus started, this was our primary emphasis – charge capture.  Our mission was to help physicians (who are on the go) to identify their visit with the patient, rapidly and accurately identify the service they provided, and choose the diagnoses for which the patient was seen.  This was back at the turn-of-the-century when people used to use things like paper or palm pilots that didn’t have Wi-Fi or cellular data (kids – ask your parents, they can tell you about such things).  By developing user friendly mobile tools to allowed providers to perform these tasks, we were able to help providers capture all of the revenue that they had earned by their work with patients.  Given how thin the margins are in healthcare, often the increase in revenue from capturing missing charges (as well as the reduced overhead from transitioning off paper) would be the difference between being in the red and being in the black.

You’d think the problem would be solved by now, but twenty years later, charge capture is still an issue.  While some EHR vendors have thrown their hat in the ring and integrated charge capture into their clinical, we’re still finding lots of physician groups that are losing revenue from poorly designed charge capture applications or workflows.  Whether their all-in-one solution isn’t as robust as it could be, they’re still on paper with back-office staff entering their charges, or they simply forget to record all of their charges into whatever system they use, a significant number of charges are lost.  Part of the difficulty is the lack of reconciliation tools.  The back-office only knows to look for a charge if they have a way of knowing that a charge opportunity happened.  Without appointments (like in the inpatient setting) it can be very difficult to know who the provider saw, and this makes reconciliation very difficult leading to lost charges.  This has been one of the unexpected but significant benefits of our Assign product (which automates and adds intelligence to the assignment process of patients to providers each day).  Since the system automatically assigns the patients every day, it knows exactly which patients each provider was supposed to see each day, and this closes the loop on reconciliation.  So, by trying to branch out and help our customers with a new problem, we also were able to help them with an old one at the same time!

I’m not quite sure where how medicine is going to continue to evolve (remember, I don’t predict things anymore), but I’m confident that physicians and other healthcare providers will continue to need technology to help them deliver the highest quality care to their patients, and receive payment accordingly, and we will continue to help them do so.