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Charge reconciliation is frequently not done. To remind people what charge reconciliation is if you haven’t heard any of our podcasts or haven’t read any of our articles, charge reconciliation is basically making sure that all of the patients’ encounters actually get entered into a billing system they can then be submitted. A subsector of this could, of course, include whether the charges actually get introduced. Still, really we’re talking about, “Did it ever get entered into the billing system rather than just disappear into the void?”

Why is charge recon so important?

Charge reconciliation, essentially, is that process where you’re looking at both systems. So if there’s a separate clinical and a billing system or if it’s all in one system, then essentially we’re looking in the billing module and comparing that to clinical to see whether that’s in a scheduling calendar or whether it’s in LIS, whatever it might be (results, surgeries, and so on), whether or not those things actually made it into the billing system, forget even whether or not they got billed.

You’ve probably heard me say this before, “When you don’t do charge reconciliation, encounters go poof into the void.” But when it is done, it’s often not done correctly or entirely. That means even when charge reconciliation is done, often there are still charges that are missing. Even a more nuanced version of this is that line items are missing, like one or more CPT codes.

To do it right is actually massively time-consuming and really not something that a biller can do. It requires a billing manager or a practice manager, or a financial analyst. Basically, it’s somebody who’s very expensive. Not just expensive in terms of what somebody is paid individually, but we’re talking about massive opportunity costs. What else could be done with this person, whether you or somebody else in your organization?

When to initiate charge reconciliation

What else could be done by this person in that time consumed currently by doing reconciliation or, worse, if nobody’s doing the reconciliation and the charges are just going poof and disappearing? The presumption here is that somebody actually is doing reconciliation, and it’s consuming a lot of time. If you’re not doing reconciliation, get started quickly.

While we’ve known all along it was really time-consuming to do charge reconciliation, we’ve never really before had an external quantification where somebody tracked themselves how much time it was taking beforehand and then what time was saved after we automated that process.

Why automation works

When we first built charge reconciliation, it wasn’t within Apache Health. We created this concept back when we had a billing company called Cobalt Health. We made it ourselves because we needed to use it ourselves. After all, clients were screaming at us and saying, “Hey, you haven’t billed everything.” And we were saying, “Well, we billed everything you gave us.” So when we built that for ourselves once upon a time, we never quantified the time savings. The reason why we never quantified the time savings is that we hadn’t done it before.

So it’s not like we were doing this all along, and then we somehow created the software that automated and saved our managers time. We’d never done it. So there wasn’t really time savings. Nobody was doing it in Excel. Nobody was doing it manually or anything like that. And then, we automated it. We just created it from scratch with an automated process because that’s kind of how we operate. So we didn’t really have a pre and post to quantify how much time was being taken by managers beforehand because we weren’t doing it.

Final thought

We now have an external organization of clients, a billing company, who has given us their estimate, based on what they were quantifying and tracking for the time consumption beforehand and how much time has saved. So our charge reconciliation application is saving… You know what? I’m going to leave you with a cliffhanger. I will give you the number in the next episode.