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Home > Case Studies > Patient Charge Capture & Reconciliation Improvement Project

Patient Charge Capture & Reconciliation Improvement Project

Client Situation:  Our hospital client was concerned over the accuracy of patient charges and supporting documentations.  The focus of concern was the client's current charge capture process and associated effectiveness.  This particular process area had been studied in the past by other consultants and internal groups with little impact or material improvements.

Endeavor Management Solution: Endeavor Management was commissioned to work with internal Clinical and Financial Resources to measure the effectiveness of the charge capture process, and to determine potential impact on compliance and various regulatory programs (e.g., Medicare).  Additionally, expected financial benefits were developed based on under and overcharge opportunities. With Endeavor's assistance, a cross functional work team "PAS/PFS Redesign Team" was formed to focus on reviewing the statistically generated patient bills, determining the error rate, and developing a root cause analysis.  The team developed a detailed spreadsheet tool and used this tool to audit and analyze three (3) major areas:

  1.  235 random and statistically generated patient bills, containing 6,255 line charges,
  2. 426 Perioperative accounts and,
  3. 673 infusion therapy and injection charges.   
Each area was further subdivided to list possible root cause errors - based on various criteria such as department, and patient type - and estimated financial impact.  Our analysis also included the process that involved physician orders capture and documentation.   Endeavor Management provided the team with process analysis and root cause tools and techniques as part of the engagement.  From the onset, objective was to transfer knowledge to client staff that would empower them with business process analysis and management skills.

Results and Benefits:  Revenue enhancements of 5-9 $M per year were identified associated with the failure to capture appropriate charges that the current process was unable to capture.  An additional benefit of 4-7 $M were identified via recovery of lost charges associated with insufficient or incorrect documentation.  The final team report included a list of additional specific process re-engineering changes needed to realize benefits at little to no added cost.   All Report recommendations were accepted and implemented by client staff.