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January 24, 2012

Perfecting Your OR Charge Process

When looking at your Operating Room’s (OR) charge capture process, no hospital wants to jeopardize their financial stability because of mistakes and inaccuracies that could have easily been avoided.

In this offering of Off the Shelf, we present how healthcare facilities are strategically tackling OR charge capture by establishing a proficient system that reviews all documented items to be billed and identifies the errors/inconsistencies so that charges can be rectified before billing the patient. 

When errors go unnoticed, hospitals can endure costly penalties, delayed payments, increased time in accounts receivable, and decreased patient satisfaction, which not only hurts the OR but ultimately affects the hospital’s bottom line.

Hospitals have been known to get penalized for charge capture errors (see Penalized Teaching Hospital).  Help your facility avoid these penalties by establishing efficient charge capture processes and policies for continued success.

Potential Problems

One of the main difficulties with capturing charges in the OR is determining the methodology best suited for your institution.  There are two typical ways to capture charges in the OR: inclusion and exclusion.  Inclusion involves documenting every item that was used to perform the procedure and charging accordingly.  Exclusion includes a list of all materials that could possibly be used during a procedure and crossing off all of the unused items and billing for the remaining supplies.

But as with any process, there is a potential for problems to surface.  When charging for procedures in the OR, some items may be left off the list of items used/unused, some may be repeated on the list multiple times going unnoticed, and some may be listed under a different name causing inaccurate records.  Common problems for capturing charges for OR supplies and equipment include:

  • Outdated/lack of maintenance of information systems
  • No ownership or management of the processes/procedure
  • Lack of standardization of items/nomenclature
  • No auditing program or verification process established in the department
  • Lack of departmental coordination; decentralized responsibilities
  • Inadequate policies, organizational supervision, and benchmarks to monitor performance
Ensuring Success

With this said, there are steps facilities can take to resolve charge capture inaccuracies and ensure a successful process in the OR:

  • Maintain an accurate case schedule in the OR.  Verify that the scheduled number of cases coincides with the number of completed cases to avoid discrepancies.
  • Review surgical cases each day to anticipate charges and efficiently capture expenses to process billing correctly and in a timely manner.
  • Keep item numbers linked with current contracts to maintain effective pricing controls.
  • Establish a system that ensures process controls for billing procedures.  For accurate charges, those responsible for reconciling OR expenses should not also be responsible for documenting costs to patients.
  • Catch charge capture errors early on in the process so they can be corrected before bills are sent to patients.  This also allows for staff to be retrained regarding charge capture and compliance sooner rather than later to stop errors and inconsistencies.

The OR is a major focus of operations as well as being a high-cost area for the hospital.  Constructing an accurate process for capturing charges is a constant undertaking.  As a result, it is essential to the success of the facility that its practices and processes operate at a high level of efficiency.  By examining the facility’s charge capture policies and procedures, hospitals can effectively tackle the difficulties of charge capture in the OR and considerably increase revenue and productivity.

Soyring's Solution

Does your facility need help reviewing and revising its charge capture process?  Contact Us. 

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