charge capture, radonc

The Future is Now: One Clinic’s Story of Improved Charge Capture

Matthew Terry, VP of Clinical Consulting

Mar 19, 2024

A freestanding group of nationwide radiation oncology clinics enlisted our help for one of their western U.S.-based clinics, which had two linear accelerators. While initially they were primarily interested in increasing revenue and improving compliance at the organization, they soon came to experience a great deal of additional value in improved charge capture learnings for the front-line staff and streamlined operations. After implementing S!GNAL, the organization was able to reduce coding and documentation errors from the front-line clinical team and cut back on manual review of charge capture for huge efficiency gains on multiple fronts. These include a 5% error rate improved from 14.4%, and a reduction in manual review of daily charges from 99 per day to 6 per day, saving staff valuable time and making operations much more efficient. 


Fuse’s S!GNAL technology integrates with the customer’s oncology information system (OIS), ARIA from Varian Medical Systems, to ingest complex data and highlight workflow inconsistencies based on a predetermined set of rules. By automatically detecting potential problems like missing codes, incomplete documentation, and compliance concerns, the customer end user was able to identify and correct issues right away. Additionally, they were able to proactively educate staff and make changes to coding processes and/or documentation templates to prevent future errors, omissions, and discrepancies. As problems were regularly flagged, these continuous identifications served as regular opportunities to educate and remind employees about inconsistencies and incorrect charge capture instances. Further, our software predicted additional instances for revenue that the site had not initially captured, leading to generation of entirely new charges captured. 


The charge capture improvement process began with our experienced consultants sitting down with the customer to determine the rules set, or “guide rails” that keep employees where they need to be. We share our knowledge about CMS and local payer requirements as well as lessons learned from other customers along with our general coding expertise. We discuss expectations, wants for charges and document needs, and establish a sort of “official” set of rules for the workflow, which most sites do not already formally have in place. S!GNAL provides real-time monitoring of how closely their clinical staff stick to the rules we’ve established collaboratively, which we call activity standardization. The ongoing guidance by the technology allowed the end user to provide constant front-end staff education which was a very effective teacher. The impact was the activity standardization improved and quantity of material for end user review went down—way down. 


When our collaboration began, the end user would have manually reviewed 2,269 charges (99 charges per day) in the first month. Because they used S!GNAL, 81% of charges coming through the system were found to follow the workflow rules (activity standardization); so now the end user only needed to manually review 428 charges (19 charges per day). A mere four months later, workflow improvements and staff education resulted in 93.4% activity standardization; so now the end user only manually had to review 116 charges out of the total 1465 (6 charges per day).  


We see this as a positive and significant improvement for two reasons: S!GNAL reduces the total charges needing review manually and reinforces behavior change. “You captured this correctly but forgot to put the document in,” or “you captured this service on the wrong date” not only allows the issue to be corrected, but also provides redirection of future behavior. We see that without a software system in place that can evaluate adherence to protocol for each charge for each patient every day, it is extremely difficult to implement standardized processes and track adherence.   


In addition, the actual error rate of charges and its supporting documentation by the end of the workday fell from 14.4% to 5%, an improvement confirmed by the customer. Again, this significant change is due to consistent staff guidance provided by S!GNAL.   

Everyone at the customer site is experiencing daily, real changes happening in the clinic. The increased activity standardization and decreased error rate has provided major improvements, and profitability is the evidence. It is a true partnership for success, and we welcome new potential partners to reach out about how this paradigm-shifting solution will help you realize next-level performance through improved charge capture, timely resolution of errors, and continuous automated monitoring of data. The future of radiation oncology operations is now!


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