Schedule For Successful Chargemaster


You more successful as you've got things on a schedule and you're more devoted to doing them

Know the tasks that you should do on a daily, monthly and annual basis for Chargemaster maintenance. So daily task, a big part of Chargemaster maintenance, making sure it works well for you is auditing those internal edits, those pop-ups at the point of medical billing that are creating problems, that are creating slowdowns in work, creating potential lost reimbursement.

So you need to take a look at what are the big edits that are heading all hospital that can be attributed in part or in whole to the Chargemaster. You're going to have to prioritize those. Hopefully there aren't a lot. But it's something you need to look at on a daily basis.

Now, some of it is not going to be a CDM issue. You don’t necessarily have to get involved with every edit out there. Hopefully, someone is. But you do need to look at the ones that could be a potential Chargemaster issue.

It's the HCPCS code for example is not one that’s valid for the payer that could very likely be a Chargemaster issue. Hopefully, one that can be resolved very quickly.

Medical billing Training Expert Pointers

On the weekly tasks, it is recommended weekly that you review payer bulletins and listservs. Now, you might do this daily as they come into your inbox.

Mar 26, 2019
Duane C. Abbey

If you need to do it more often or it works more often for you, that's fine. Move it to the daily task.

The monthly or quarterly task, it just depends on what the need for your facility is, a taskforce meeting. When we say taskforce, it could be the Chargemaster committee, whatever it's phrased. Sometimes it's the revenue cycle committee, whatever. If it's a committee that talks about and touches the Chargemaster, that's what we're talking about here.

Also on a quarterly basis, you're going to have to review the outpatient code editor changes, the Correct Coding Initiative changes, all of those issues. So what we're recommending here is has to help you create your own to-do list is think through those daily tasks that are important to maintain in the Chargemaster, same thing for weekly, monthly.

That way, a lot of them don’t flip through the crack or you have already devoted on your calendar certain time to them. Now, let's go ahead and move to slide number six. Now, this is monthly one as you can see January, February, March, April, May, et cetera. So just give you a little bit different look at it.

But some over a period of a year, items that we do think that you need to spend some time on. It might not be the specific months listed here.

In January and June, there should be a lost charge review. Now, that's not something that’s going to be necessarily done by the Chargemaster coordinator. It could be outsourced to a vendor or it could be something, sometimes the nursing does it, sometimes HIM, sometimes billing who have does it.

But a lost charge review is very often, it very often highlights some Chargemaster issues. You might not think it does but it does because what someone is billing as one charge item, might be documented as multiple items.

So think about doing at least minimal lost charge revenue. You'd probably be surprised at what you find. In February and in July, again, it doesn’t have to be these months, a medical billing audit. And this is outside of that daily maintenance of edits that come up. This is someone taking a look at sampling of charge to see if they are billed correctly with the right codes, with the right charges.

So it's a charge audit, a coding validation. Take a look at that entire UB and making sure everything on it is correct.

Internally, we suggest you do it at least twice a year. If you outsource it, then that might be once a year whatever works for your facility but it is something that needs to be done. It needs to be done with someone who has the right level of expertise for it.

Now, in July, you can take care of review proposed changes and outpatient perspective payment system. We didn’t say the inpatient perspective payment system. You might need to it usually just has less of an impact on the CDM.

So review the proposed changes. Introduce it to your Chargemaster committee and then start talking about the implications of it.

In August, because it takes a lot to go through those changes, it takes a while to funnel the information out to the committee and for everybody to think through it, walk through the impact of those changes.

And what we mean by that is how is it going to impact your reimbursement? How is it going to impact your medical billing blow? How is it going to impact your quality of care, anything? Walk through the impact of the changes and how you're going to address those. Now, remember, we're not saying implement any changes yet.

Then in November, we have the CPT update that we have to contend with as well with the drop date of January. So you're going to have when we get that information in November, it's pretty much final. So we can go ahead and act on that for a January date of service implementation.

You also need to do some contract reviews with your non-Medicare payers. Are they making any changes? Are there any issues that you need to negotiate better in your contract? So we think the Chargemaster maintenance, our Chargemaster coordinating folks need to be a part of contract negotiations so it need drive it finance or others will do that. But you need to be involved in the process. You need to know how it will impact the Chargemaster.

And obviously, in November, we want to review the final changes in the APC system. And role out the plans for changes and implement those changes that you can.

So just an idea of some calendar items that you might want to start incorporating and we think it'll help make you more successful because you've got them on a schedule and you're more devoted to doing them.

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