Ensure that any resolutions you put in place actually work over the long term
What are some of the keys to Chargemaster success? You should identify your top medical billing issues that you get edits on, common edits on or that your taskforce has said this is a problem for us. And you need to prioritize those. What is the most impactful from a financial perspective? What is the highest volume, what is the greatest risk? Any that fall into biggest impact to reimbursement, highest risk, most volume, those are the ones that you should address first.
And as you're working with your committee on some of those medical billing issues, then you're going to want to establish accountabilities in resolution. So we're going to talk again a little bit more about how to work with the committee or the taskforce with Chargemaster. But you're going to want to make sure that when you identify these top issues, there's a plan of action. And someone’s held accountable for making it work.
Also you need to provide educational sessions with the appropriate staff. So as you find the medical billing training problem areas, you've identified these priority problems and they're at least in part Chargemaster issues. So we're going to make these changes.
Then you need to say who needs to know about these changes and at what level. No need to assess the information system’s capabilities. Do you need to bring IS in and say, “This is doesn’t work for it. There's a breakdown in the system. What's going in? Is it coming in at the point of billing?” So you want to make sure that before you do that education, your system can work well and work correctly.
Also the Chargemaster coordinator needs to stay involved in consulting projects. What we mean by that is if the hospital outsources a consulting project that in any way talks about the coding or the charging that comes from the charge description master, the CDM coordinator needs to stay involved in that process. They need to hear the discussions. They need to hear the recommendations so that you can say okay, that works, that makes sense, we can do that or here's the problem with it.
So make sure you stay involved. It's also a good way of you're staying informed on maybe some of the information that those consulting projects can share. So it's a win-win for everybody.
Also you want to make sure you've identified the issues, you corrected them, you've educated. Now, you want to make sure that you monitor. Are we maintaining it correctly? So you want to make sure that any resolutions you put in place actually indeed work over the long term.
Because sometimes what hospitals will put in some good fixes. And then six months later start getting edits from one department. Well, maybe it's because they're charging system wasn’t corrected. We got everybody but that one department. So monitor it over the long haul to make sure.
And you want to make sure that you're measuring it consistently. So if you have let's just say you've looked at your top five issues from an editing perspective and if you annualize them out, they would cost you million dollars if you didn’t resolve them.
Medical Billing Training Tip: So you put the right programs in place. You correct the Chargemaster. You educate, et cetera. And now, you're measuring. And so, what you want to see is okay, what's costing us million dollars, we've corrected it. Now, we're making that million dollars or the right percentage of that million dollars.
When you do that, make sure you're measuring apples to apples. You're looking at the same figures. Just to make sure that you're supporting correctly what you've done, the monitoring process.
Okay, some examples of some issues that you might see, you might run reports that are based on the outpatient code editor edits. Maybe invalid dates are entered. Well, that might be a big issue that's really impacted your hospital, probably not a Chargemaster issue.
It might be coming from the demographic information and so, that's an error outside your control. That's okay. Just make sure the right people handle it. Medical necessity edits, this is where perhaps you're billing for a lot of services without a diagnosis that supports the service being performed. So you're going to get a denial on it.
And again, maybe this isn't a Chargemaster issue. You definitely want to make sure if you're getting medical necessity denials for one particular section of codes with this lab that those codes are correct on a Chargemaster and reflective of what's being performed because maybe there's a problem there. And the correct code wouldn't have cost the edit.
Likelihood is perhaps we didn’t do a good job with the ABN or the ICD-9 code might be missing along. But you still need to look at it beyond just what the face value is.
What are the news center requiring HCPCS? Well that probably could be very much a Chargemaster medical billing issue. That would be the one that you would want to take hold of and make sure it's correct. Just don’t ignore the rest of it and thinks it's not necessarily your ownership because there could be aspects of it all that are. So make sure that whenever you see high volume edits that any aspect of that edit that might be Chargemaster for them is clean.
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