Validate your Charge Capture

Valetude Charge Capture uses sophisticated algorithms to scan claim data on both the UB/837 and itemized patient account bill to determine missing soft-codes, procedures, or supplies and pharmacy (services provided but excluded from initial claim) and the type of missing charge.  Billing opportunities are identified via on-screen reports, managed through a workflow engine tool, and data is displayed on an integrated scorecard to view process results and ROI. In addition, ideas are easily added and tailored to accommodate client specific facilities and business models.


Charge pairs is a methodology by which we establish that the existence of certain charges on a claim should almost always be accompanied by other specific charges.  If those implied charges are not present, the claim is flagged for potential re-billing and put in a work queue that is managed in the context of the Valetude system.


In addition, special queries identifying statistical exceptions are run that identify claims with potential for additional reimbursement via re-billing.  Finance and clinical personnel use the Valetude “cradle-to-grave” work flow system to assign status codes and enter other information relevant to potential/actual re-billing.  Valetude can track pending and actual additional reimbursement for all re-bills to highlight the value of this revenue cycle improvement.


Our multifaceted approach to identifying missing charges allows your staff to focus their efforts in high probability opportunity areas:

  • Analyze common relationships between HCPCs- ie drug administration implies a drug, surgery implies anesthesia, or a specific procedure implies a specific implant.
  • Define relationships between Charge Master items that are specific to a facility.
  • Identify statistical relationships – view commonly related HCPSs and/or CDMs at your facility to develop facility specific charge capture checks.
  • Promote facility specific learning – after using the standard charge capture library that comes with Valetude, leverage the software to dig into the specifics of unique facility operations and charge master.
  • Use commercial payer contract data loaded into Valetude to focus charge capture efforts in areas where additional charges drive additional reimbursement.
  • Re-direct the same logic functionality for use in compliance issues including RAC analysis.



 

"We initially thought that we had the tools and controls in place through existing systems, consisting primarily of compliance based edits and standard claim scrubbing. Upon further review, we became aware of missed opportunities and with Valetude software and support, have captured an additional $18M in net revenue over the past 3 years. The software allows us to build complex queries tailored to our specific facility that identify missed charges; we are also able to quantify the financial impact of rebilling any particular missed charge so we can prioritize our efforts.”


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Director, Revenue Cycle Management

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