Workflow — Charge Capture & Reconciliation

Find every undocumented, late, or missed charge before the bill drops.

Charge tickets, EMR documentation, supply utilization, OR records → undocumented / late / missed charges identified, NCCI edit compliance, charge-vs-documentation reconciliation. Corrected charge file into Epic Resolute, Cerner Revenue Cycle, or athenahealth Collector. Replaces charge integrity teams plus offshore charge-review labor at a fraction of the per-encounter cost.

Take the AI Assessment Get a Per-Encounter ROI Model

$45–$95

Per hour, charge integrity analyst (loaded)

NCCI

CMS National Correct Coding Initiative edits

60–85%

Routine charge review off the desk after AI cutover

What This Replaces

The Charge Integrity Team Reconciling One Encounter at a Time

The work the charge integrity analyst does on every encounter — and the cost of leaving it there.

The labor

Charge capture and reconciliation today moves through charge integrity analysts at $45–$95 per hour fully loaded plus offshore charge-review support at Cognizant, Optum, Conifer Health, R1 RCM, GeBBS Healthcare Solutions, Access Healthcare, Sutherland, EXL Healthcare, AGS Health. Per-encounter charge review is bandwidth-bound — analysts review samples or by-exception, leaving most encounters un-reconciled and revenue capture incomplete on procedures with documented services that never become charges.

The cycle time

Standard charge integrity workflow runs by-exception or sample-based — most encounters never get full documentation-vs-charge reconciliation because the analyst economics don't cover the full population. Late charges, undocumented services, missed supplies, and NCCI-edit-driven denials silently erode net revenue. Charge integrity teams typically capture only the most obvious gaps; the long tail of small per-encounter losses adds up to seven-figure leakage at mid-size health systems.

The Workflow

Input · Analysis · Output

What goes into charge capture, what we do to it, and what shows up in the billing system.

Input

Charge tickets + EMR + supply data

Charge tickets from clinical departments
EMR documentation (notes, orders, MAR)
Supply utilization records (par cabinets, RFID)
OR records (anesthesia, implants, time-in / time-out)
Pharmacy administration records (eMAR)
Lab and radiology orders / results
Per-encounter charge master (CDM)

Analysis

Reconcile, identify, NCCI-check

Charge-vs-documentation reconciliation
Undocumented charge identification (charges without supporting docs)
Late-charge detection (services rendered, charges not posted)
Missed-charge detection (documented services without charges)
NCCI edit compliance (PTP edits, MUE limits)
Modifier appropriateness check
Confidence score per finding; exceptions to charge-integrity-team queue

Output

Corrected charge file into the SoR

Corrected charge file into Epic Resolute
Cerner Revenue Cycle / Oracle Health
athenahealth Collector
NextGen Healthcare HIS billing
Revenue capture report by service line / by department
NCCI-edit and modifier-flag dashboard
Per-encounter audit trail with charge-vs-documentation basis

Side by Side

Charge Capture & Reconciliation Today vs. With Last Rev

The numbers that matter: cycle time, encounter coverage, accuracy, and revenue-capture impact.

Dimension	Charge Integrity Team + Offshore	Last Rev Charge Capture
Cycle time, encounter to reconciled charge file	Days at the analyst desk	Same-day per encounter
Encounter-population coverage	Bounded by analyst time — sample / by-exception only	100% encounter-population reconciliation at AI cost
Per-encounter unit cost	$45–$95/hr analyst translated per-encounter	Per-encounter, benchmarked at 25–45% of analyst unit cost
NCCI edit compliance	NCCI checks via encoder, drift on edge cases	NCCI edits applied per encounter with the PTP / MUE basis cited
Late / missed charge detection	Spotty — depends on analyst sampling	Per-encounter detection with documentation-evidence cited
EHR / billing integration	Manual / batch reconciliation into Epic Resolute / Cerner / athena	Direct via documented Epic / Cerner / athena APIs
Audit log per finding	Analyst notes, no per-charge lineage	Source documentation + CDM lookup + NCCI rule + confidence per finding

How It Works

From Encounter to Reconciled Charge File

Five steps. Every one logged. Every one reversible if your confidence threshold isn't met.

Submission Lands

Charge tickets from clinical departments, EMR documentation (notes, orders, MAR), supply utilization records, OR records, pharmacy administration records, and lab / radiology orders pulled from Epic, Cerner / Oracle Health, or athenahealth — paired with the per-encounter charge master (CDM).

Extraction & Classification

Charge-vs-documentation reconciliation per encounter. Undocumented charge identification. Late-charge detection. Missed-charge detection (documented services without charges). NCCI edit compliance (PTP edits, MUE limits). Modifier-appropriateness check.

Validation Against CDM and NCCI

Findings validated against the hospital's CDM and CMS NCCI edit rules. Anything below your confidence threshold per finding is routed to the charge-integrity-team review queue — final charge correction remains with the regulated entity.

Push to Billing System

Corrected charge file into Epic Resolute, Cerner Revenue Cycle, athenahealth Collector, or NextGen via the documented integration. Revenue capture report by service line and by department. NCCI-edit and modifier-flag dashboard updated.

Audit Log Persisted

Every charge-vs-documentation match, NCCI edit application, and modifier-flag decision logged with the source documentation, CDM citation, model version, and confidence score. Payer-audit-ready and yours.

Compliance & Defensibility

Built to Meet the Quality Bar Charge Integrity Already Runs On

CMS NCCI / NCD / LCD conformance

CMS National Correct Coding Initiative (NCCI) PTP edits and MUE limits applied per encounter. NCD (National Coverage Determination) and LCD (Local Coverage Determination) rules applied per claim. Per-quarter NCCI / NCD / LCD updates flow into the validation engine within days of effective dates.

CDM accuracy and CDM maintenance

CDM (Charge Description Master) integrity checked per encounter — services billed match CDM-published codes, descriptions, and rates. CDM-update cycles supported per facility. The audit log records the CDM version used per encounter.

Payer-audit and OIG defensibility

When payers post-payment audit (RAC, MAC, OIG, commercial-payer audits), the audit log produces what was reconciled, which CDM entry applied, which NCCI / NCD / LCD rule applied, and what the documentation basis was. Cleaner chain of custody than the analyst spreadsheet today.

PHI / HIPAA / HITRUST posture

Encounter charge data contains PHI under HIPAA. Deployable in your VPC or our SOC 2 / HITRUST / HIPAA-aware environment. Encryption in transit and at rest; retention policies tied to your HIPAA / CMS billing-record requirements.

Common Questions

What Hospitals and Health Systems Ask About Charge Capture

Those are the systems where charges, reconciliations, and billing data live. The competitor on this page is the charge integrity analyst labor that does the actual reconciliation work — typically analysts at $45–$95 per hour fully loaded plus offshore charge-review support at Cognizant, Optum, Conifer Health, R1 RCM, GeBBS Healthcare Solutions, Access Healthcare, Sutherland, EXL Healthcare, AGS Health. We undercut that labor cost, integrate directly into your existing Epic / Cerner / athena deployment, and deliver corrected charge files into the system of record.

Most hospitals and health systems keep the charge integrity team and offshore arrangement in place during pilot and early production — we route exceptions, complex multi-service-line cases, and any encounter that genuinely requires senior-analyst judgment to the team you already have. Volume to the offshore charge-review desk drops 60–85% on routine reconciliation once cutover completes. Charge integrity analyst time shifts to higher-leverage work like CDM optimization, payer-policy-driven charge integrity, or audit-defense engagements.

Our pilot success threshold is charge-vs-documentation reconciliation accuracy at parity with or above your incumbent charge integrity process, measured on the same shadow-data sample of historical encounters. Anything below your defined confidence threshold per finding is routed to the analyst review queue — your call which queue, ours or yours.

Per-encounter AI reconciliation costs are largely fixed regardless of encounter population, so 100% reconciliation becomes economically feasible where sample / by-exception was the only option before. Late, missed, and undocumented charges that previously slipped through the analyst sampling now surface for charge-integrity-team review with the documentation basis cited. Net revenue impact at mid-size health systems routinely runs into the seven figures.

CMS NCCI PTP edits and MUE limits are applied per encounter with the PTP / MUE basis cited. Modifier-appropriateness checks (modifier 25, 59, 51, etc.) run against the documented services. NCCI / NCD / LCD updates flow into the validation engine within days of effective dates so post-payment audits resolve cleanly.

Yes — through the documented integration surface each platform supports. Epic via App Orchard / FHIR APIs; Cerner / Oracle Health via FHIR APIs; athenahealth via REST APIs; NextGen via documented integration patterns. Your IT, clinical, and revenue-cycle teams review and approve service accounts. We do not require platform-side custom development.

Charge-capture pilots typically run 6–8 weeks: 1–2 weeks of integration and per-service-line CDM mapping with the charge integrity team, 4 weeks of shadow-mode running on real encounters with no billing-system writes, 1–2 weeks of supervised cutover on a constrained scope (one service line, one campus). Production rollout is staged after the pilot meets your accuracy and revenue-cycle-management sign-off.

We benchmark against your current per-encounter fully-loaded cost — typically derived from $45–$95 per hour analyst rates translated into per-encounter economics. Our target is 25–45% of that per-encounter cost at higher accuracy, faster cycle time, and 100% population coverage. Pricing structures around volume tiers and outcome SLAs (net-revenue capture), not hourly billable rates.

Two Ways to Start

Take the AI assessment for a structured read on charge-capture feasibility. Or talk to us if you already know charge integrity bandwidth is the constraint on your net-revenue capture.

Self-serve · 8 minutes

Take the AI Assessment

A short structured assessment that maps your annual encounter volume, EHR / billing system, and current charge integrity team or BPO arrangement to AI feasibility and ROI.

Talk to a specialist

Get a Per-Encounter ROI Model

Send us your annual encounter volume, your EHR / billing system, and your current charge integrity team or BPO arrangement. We'll come back with a per-encounter unit-cost comparison and a 6–8 week pilot plan in 5 business days.

Other Workflows

More Healthcare Admin Workflows We Replace

The same approach, applied to the other document-heavy labor lines on your healthcare-admin budget.

Inpatient / Outpatient Coding

H&P, op reports, discharge summaries → CPT, ICD-10, MS-DRG. AAPC / AHIMA-aligned coding.

Clinical Denial Appeal

Denial letters and medical records → payer-policy-cited appeal letters with evidence chronology.

HCC Coding Review

Progress notes, discharge summaries → HCC capture per MEAT criteria. Submission to CMS RAPS/EDS.

Prior Authorization

Physician orders + clinical notes → InterQual / MCG match, payer-portal submission, status tracking.