Using point of service clinical documentation to reduce variability in charge capture.

Data collected at bedside to document patient care can also be used to generate an itemized summary of charges including activity-based clinician charges. This approach becomes advantageous when the charge capture operation is transparent to the clinician who would otherwise have to review the care documentation, recall the appropriate charging rules, and exercise discretion in capturing charges. Documented procedures and supplies convert directly into patient charge rules. Documented patient care is more difficult to translate into activity-based charges because nursing care can vary in intensity and duration depending on the patient's needs. The problem can be overcome by embedding time or data-driven logic into the charging rules. Using this approach in the labor and delivery units of 7 IHC hospitals (114 beds), we generated consistent charge summaries. We improved the accuracy of patient charges from 65% to over 98% of our charge summaries having no missed charges.