Ensuring that detail patient bills are complete and accurate prior to creating payor-specific claims is a critical component of Revenue Cycle Management. Unfortunately charges are regularly left off of patient accounts due to faulty processes, inconsistent implementation, staff turnover or simple human error. Catching these costly mistakes is crucial to creating and maintaining a healthy bottom line. Often, capturing missed charges is attempted by spot-checking patient bills, manual chart audits and resource training sessions. Without a consistent approach, charges continue to be left off, resulting in unclaimed and lost revenue for services already rendered.

Creating a reusable set of clinically derived rules and applying those rules to every patient bill prior to claim creation is a proven process that now assures that one provider captures all entitled revenue for services performed and supplies used in their delivery of patient care. One particular provider found that the most efficient way to accomplish this coverage was to automate the process. (The client speaker for this presentation is to be determined.)