In an increasingly complex healthcare environment, ensuring that every service provided is accurately captured and billed is crucial. A clinical charge audit identifies missed charges and ensures correct coding, directly impacting a facility’s bottom line and compliance standing. By improving charge capture, a facility can maximize reimbursements, ensure compliance, and streamline their revenue cycle.
Primary Reasons to Conduct A Clinical Charge Audit
- Optimize Revenue Capture & Financial Health
- Reduce Denials & Enhance Cash Flow
- Enhance Compliance & Mitigate Risk
- Improve Operational Efficiency
- Build Transparency & Patient Trust
Examples of Charge Audits
Comprehensive charge analysis can have significant impact on the financial and operational success of any organization. Whether a healthcare system needs to focus on the accuracy of charges for outpatient services, review charges of a fast-paced emergency department, or examine room fees and equipment usage, there are different types of charge audits to improve compliance and ensure proper reimbursement.
- Outpatient & Inpatient Charge Capture Audit
- Facility Charge Audit Emergency Charge Audit
- High-Cost & Supply Audit
- Emergency Department (ED) Charge Audit
- Medicare & Medicaid Compliance Audit
Clinical Charge Audit Case Study
Managed Resources recently completed a clinical charge audit of a large U.S. medical center with over 350 beds. After implementing a new EMR system, our client began to experience issues with the Level of Care (LOC) charged, prompting financial and compliance concerns. After reviewing 170 accounts post-EMR transition, Managed Resources discovered a significant error rate (33%), and percentage of errors resulting in revenue loss (63%).
Issues discovered in this clinical charge audit included instances of undercoding and overcoding, resulting in inaccuracies and revenue loss. Our Clinical Charge Audit Case Study can be viewed or downloaded here.
Benefits Of A Charge Audit
Maximize Revenue
Maximizing revenue through a clinical charge audit ensures that every service rendered is accurately captured, documented, and billed, leading to optimal reimbursement and minimizing revenue leakage. By identifying and addressing discrepancies, a facility can enhance financial performance, improve cash flow, and maintain compliance, ultimately supporting sustainable growth and operational efficiency.
Reduce Claims Denials
Reducing claims denials through a clinical charge audit helps identify and correct coding, documentation, and billing errors before submission, ensuring timely and accurate reimbursement. By addressing the root causes of denials, a facility can improve cash flow, streamline the claims process, and enhance payer relationships. For example, by conducting a clinical charge audit, a hospital may uncover that certain outpatient services are consistently being denied due to missing or incorrect CPT codes.
By correcting these issues and ensuring that codes are properly matched to the services provided, the hospital can resubmit claims, resulting in faster and more accurate reimbursements. This not only reduces the administrative burden of dealing with denials but also improves cash flow, allowing the facility to allocate resources more effectively and invest in patient care improvements.
Compliance & Risk Mitigation
A clinical charge audit is key to staying compliant with the constantly changing healthcare regulations, helping to avoid costly penalties, audits, or legal issues. By spotting and fixing compliance gaps early on, a facility can protect its reputation, reduce financial risks, and stay on top of payer and regulatory requirements. For example, an audit might uncover issues like inconsistent use of Medicare billing rules, which could result in non-compliant claims.
By addressing these issues before the claims are submitted, the facility can prevent a government audit, keeping both its finances and regulatory standing in check, while also ensuring payments come in on time and without issue.
How To Get Started With A Charge Audit
Find An Experienced Partner
When selecting a clinical charge audit partner, it’s essential to look for a firm with expertise in healthcare coding, compliance, and revenue integrity, along with a proven track record of identifying missed revenue opportunities and minimizing audit risks. The right partner should also offer customized solutions that align with a facility’s needs and workflows.
For example, an experienced partner can identify discrepancies in charge capture practices that lead to lost revenue, then provide actionable recommendations to optimize billing processes and prevent future errors. Managed Resources, Inc. is a trusted partner in auditing, that offers comprehensive, data-driven insights and a hands-on approach, to help healthcare facilities maximize their revenue, while ensuring compliance and reducing risk.
Preparing For An Audit
Once the clinical charge audit is complete, healthcare facilities can use the findings to improve processes like coding accuracy, staff training, and charge capture workflows to reduce mistakes and boost revenue. The next steps involve addressing any issues identified in the audit, prioritizing corrective actions, and setting up regular monitoring and audits to keep everything on track and ensure long-term improvements in revenue and efficiency.
My Audit’s Complete, Now What?
Once the clinical charge audit is complete, healthcare facilities can use the findings to improve processes like coding accuracy, staff training, and charge capture workflows to reduce mistakes and boost revenue. The next steps involve addressing any issues identified in the audit, prioritizing corrective actions, and setting up regular monitoring and audits to keep everything on track and ensure long-term improvements in revenue and efficiency.
About Managed Resources, Inc.
Managed Resources, Inc exclusively employs Registered Nurses (RNs) for all charge audit reviews. Our Clinical Charge Audit Team is fluent in multiple EMR systems (including Epic and Cerner), and hold credentials including: CCS, CHFP, CRCR, CCFA, CCDS, and CDIP. They possess clinical experience across multiple settings, ensuring a comprehensive understanding of various electronic medical records and clinical environments.
To learn more about Managed Resources’ Clinical Charge Audit Services, please contact us here.
