Joe Pajor, executive director of patient business services for The Stamford Hospital, didn’t have an epiphany that unbilled services were a significant drain on the hospital’s revenue generation. He knew it was a long-standing problem resulting mainly from breakdowns in the billing process, failures in the IT system and lack of knowledge among staff members applying charges. 

Pajor and the leadership at Stamford decided to take a proactive approach to end billing oversights by implementing MedAssets’ Charge Capture Audit. Charge Capture Audit applies rules to pre-bill data as it reviews 100 percent of patients’ itemized bills and then flags potential missed charges so errors can be corrected before bills are sent.

“At first it was like a hit from a tidal wave. I wondered how we were going to capture all of these charges and what to take care of first,” Pajor said. “I then realized this had been going on for years, if not decades, and we couldn’t correct the issues overnight. That is when we began to peel back the layers of the onion and prioritize.”

Charge Capture Audit has been instrumental in detecting missed charges as well as process failures contributing to the problem. For instance, Stamford’s outpatient surgery center was billing for one procedure but failing to charge for multiple procedures when they were performed. Upon investigation, Stamford discovered the problem was attributable to uman error as well as interfacing failure. When charges had been appropriately billed, they weren’t always flowing over from the start of services, which meant there was no hope of all procedures appearing on the bill.

“Charge Capture Audit is invaluable,” said Pajor. “The missing charges would have never appeared on the radar screen because procedures were already on the bill.”

Other oversights have ranged from less costly procedures such as rapid strep tests to high-cost devices such as implants. 

Three to six months after implementation of Charge Capture Audit, Stamford reduced its missed charges to a manageable level. And after a year of usage, the hospital has captured close to $1 million in net revenue.