AI-based product aims to help providers identify missed charges

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Providers continue to fall short of their charge-capture potential despite having rules-based systems and manual audits, an executive at an industry vendor contends.

“It’s estimated that missing charges and associated reimbursement—combined with audit and recovery efforts—cost providers the equivalent of 1 percent of annual revenue,” says Nick Giannasi, executive vice president of Change Healthcare.

Industry vendors are designing products to help provider organizations improve their ability to capture charges. For example, Change Healthcare is unveiling a product called Charge Capture Advisor that uses artificial intelligence to identify potentially missing charges for services that providers perform before claims are submitted.

The company contends that the result is more complete capture of services rendered without imposing additional time and effort by hospital revenue integrity teams. The use of artificial intelligence enables increased detection of missing charges to complete claims, improve cash flow, and optimize revenue, according to the company.

As its base of information for the new technology, Change has 500 million service lines and 180 million unique and de-identified claims that comprise $245 billion in charges, enabling more accurate charge capture predictions.

Healthcare organizations that use the Change application can accept AI-predicted charges if appropriate documentation is available, dismiss a predicted charge if they choose or place a predicted charge on hold pending a review. Managers can access charge capture trends in real-time, including the number of missing charges and estimated charge value, and they also can conduct a root-cause analysis and make improvements to charge rules.

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