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- The outpatient provider arena with its dynamic environment and ever-changing billing rules and regulations lends well to fragmented charging and millions of missing reimbursement dollars.
- Comprehensive and accurate charge capture and reimbursement is typically dependent on effective interaction between various areas: clinical departments, Health Information Management, IT, business office, Finance, etc.
- Disparate information systems (sometimes managed across multiple departments) must be able to effectively "talk" with one another.
- Charge capture is typically handled by clinical staff that may be unfamiliar with payer charge capture, coding, billing and ultimately reimbursement guidelines.
- Recurrent changes in the way that hospitals bill and get paid for services.
- Industry-wide overall decrease in governmental payment to hospitals.
- Increase in health care consumerism and transparency in billed charges.
- Support in development of and enhancement of Hospital Revenue Management Departments and/or Charge Integrity Teams.