Charge Reconciliation: Process, Roles, and Reporting

Timely, consistent, and accurate charge reconciliation is an important process within a healthcare organization’s revenue cycle function. Charge reconciliation involves multiple steps across various departments and needs to be included in daily workflows to capture charges quickly and apply the correct account. The charge reconciliation process need to be defined and documented to encompass steps, reports, follow-up, and roles. Additionally, it is important to identify who is accountable when completing this process and make those users known to leadership and across departments.

The MEDITECH system has multiple routines and reports to assist with the charge reconciliation process. Here are three key items that contribute to an efficient and successful revenue cycle department:

• Process – Key steps in the process include a review of accounts and charges, review of charges recorded in clinical application and patient accounting application, identification of discrepancies, correction of discrepancies, and signed documentation of process completion. Timing is crucial when reviewing charges. For example, if dictionary changes are missed that can affect the charge capture. To prevent discrepancies, documentation of completion that involves actual sign-off from the reviewing department ensures accountability and accuracy. We recommend that you keep this documentation for reference.
• Roles and Responsibilities – Charge reconciliation is combined effort of clinical departments and patient accounting. The clinical department is where the charging process takes place and patient accounting is the gatekeeper of the process. There should be at least two individuals in the clinical department trained to produce charges. Additionally, having designated contacts in patient accounting for charge-related questions is essential to an efficient workflow. Usually these same individuals maintain charge procedure listings for both clinical applications and patient accounting. This coordinated effort between multiple departments requires daily attention and prioritization to complete.
• Reporting – Reports are an important component of process because they provide written documentation of charge activity. Reports can be auto-scheduled for generation, print, or sent electronically on a daily basis. There are also tools within the MEDITECH system that allow you to review activity without creating a report. It is usually user preference on how they want to review daily charge activity, but the key objective is to stay focused on reconciling charges and discrepancies in a timely manner.

We understand that it can be a struggle to effectively manage these workflows: automatic charging is set up but not updated as documentation tools evolve, manual charge entry is confusing and often leads to inaccurate or missed charges, coding workflows are cumbersome and involve clicking through many areas of the chart, etc. On the back end, it can be challenging to keep the charge router and reconciliation processes up-to-date with the changing clinical workflows.

During our assessments, we engage a cross-functional team of clinical and revenue cycle experts to assess the health of your charge capture workflows, CDM, and reconciliation processes. We will audit your use of MEDITECH tools to facilitate accurate charging and reconciliation and review your education materials, reports, and processes in place to facilitate timely charge reconciliation. Finally, we will review your charge audit processes and feedback to the clinical areas. To start a conversation or schedule a meeting, please email us at info@cerecore.net or call us at 855.276.9112.