The centerpiece of our service is helping the hospital improve charge capture in surgery. There are three areas that are involved in achieving this goal. When all three pieces are done, charge capture improvement in excess of 90% is achieved. This approach has worked in every type and size of hospital, in every type and size of community.

Nurse Training 
In surgery, the circulating nurse generally is responsible for identifying what was used in the case. Even when case carts are used, the extra items used in the case need to be charged. Nurses selected their career because they wanted to be care-givers not accountants, that is why training is so important. If you don’t make it easier for the nurses to charge more completely, you are not likely to capture all charges.

Charge Definition 
Many charges are obvious – the charge for an ortho saw blade is just for the blade; the charge for a 1000ml of sterile saline is just for the saline. But other charges need defining to make sure they are charged correctly. Here are a few examples – does the charge for a Holmium laser include the laser fiber and smoke evacuator; does the charge for Bovie unit include the grounding pad and pencil or are consumables charged separately? What is included in the OR time charge and what is NOT included in the OR time charge?

Business Office Support 
After the charge sheets, computer screens, et cetera are set up with the various charges for the OR, they have to be readily processed by the charge entry portion of the organization. We often have nurse managers tell us they have trouble getting new charges set up. The “MISCELLANEOUS” charge is a stop-gap destination for these new charges. We do not recommend widespread use of the MISCELLANEOUS charge, but using it is better than losing the charge. It is a self-regulating item in that it will get addressed if there are a lot of charges going into it.