Charge Capture Agent
Detects missed, duplicate, or under-coded charges across encounters to protect net revenue and compliance.
Charge leakage occurs when services documented in clinical systems never reach the bill, especially for infusions, supplies, implants, and ancillary procedures
Duplicate or incorrect charges create compliance exposure and costly rework after patient statements
Late charge reconciliation across departments depends on manual audits that sample too little, too late
Net revenue and cost reporting suffer when charge integrity is incomplete across inpatient and outpatient settings
The Charge Capture Agent reconciles clinical documentation, orders, medication administrations, and device logs against posted charges to find misses, duplicates, and under-coding. It prioritizes findings by dollar impact and compliance risk and routes corrections to department charge analysts before final bill drop. Pattern analytics highlight recurring leakage points by department, provider, and charge code.
Reconcile Clinical Activity to Charges
- Compare MAR, procedure logs, supply/implant scans, and orders to CDM charges
- Identify missing, duplicate, and quantity-mismatched charge lines
- Exclude appropriately bundled or non-billable items
Quantify Revenue and Compliance Impact
- Estimate net revenue impact using contract and CDM data
- Flag high compliance-risk duplicates or unbundling patterns
- Prioritize pre-bill vs post-bill recovery paths
Route Corrections to Owners
- Assign exceptions to department charge capture owners
- Suggest correct CDM codes, units, and modifiers
- Track completion before bill hold release
Monitor Trends and Harden Capture Processes
- Report leakage by department, service line, and charge code
- Feed recurring misses into CDM and workflow redesign
- Measure late charge rates and recovered revenue