Charge Capture Advisor uses AI to flag missing charges and complete claims

Sept. 17, 2019

Change Healthcare has announced the launch of Charge Capture Advisor, a new cloud-based addition to the company’s portfolio of Revenue Integrity Solutions, at its booth (#904) during the American Health Information Association (AHIMA) conference September 14-18 in Chicago.

The solution uses Change Healthcare Artificial Intelligence to identify potentially missing charges for services that providers actually performed before claims are submitted. The result: more complete capture of services rendered without additional time and effort by hospital revenue integrity teams. 

Working alongside providers’ existing health information system (HIS), coding, billing, and manual processes as part of a comprehensive charge-capture strategy, Charge Capture Advisor brings the power of AI to help increase detection of missing charges to drive complete claims, accelerate cash flow, and optimize revenue.

“Providers are still falling short of their charge-capture potential, despite using the most sophisticated rules-based systems and meticulous manual audits,” said Nick Giannasi, PhD, Executive Vice President and Chief AI Officer, Change Healthcare. “In fact, 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. Charge Capture Advisor can help providers identify those missed charges and help improve revenue capture.”

Change Healthcare’s AI for charge capture is trained on more than 500 million service lines and 180 million unique, de-identified claims that touch $245 billion in charges. This industry-leading volume of data allows the AI model to provide more accurate charge capture predictions. Moreover, Charge Capture Advisor requires no integration with existing software, freeing the IT department to focus on its core responsibilities. Missing charge predictions are accessed in real time in the claim workflow, helping ensure claim completeness at each level.

Charge Capture Advisor is easy to use. Users can accept the AI’s predicted charges if appropriate documentation is available, dismiss a predicted charge, or place a predicted charge on hold until research and review of relevant documentation can be completed. Managers can access real-time insights into charge capture trends—including the number of missing charges and estimated charge value—so they can continually review, analyze, drive root-cause analysis, and make improvements to charge rules.

Change Healthcare’s Intelligent Healthcare Network includes more than 2,200 payers, 5,500 hospitals/health systems, and 900,000 physicians; and the associated claims data powers AI-infused solutions that transform the accuracy and efficiency of revenue cycle processes.