Auditing Your Hospital's Chargemaster for Hidden Reimbursement

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Systematic Process for a Chargemaster Audit Helps Ensure Compliance and Increase Your Bottom Line.

The chargemaster is a lynchpin within the revenue cycle for hospitals. In recent years the chargemaster and associated charges have come under increasing scrutiny.

Chargemasters are complex and can be organized in different ways. Proper charging is the key for proper reimbursement. A carefully crafted systematic process is necessary to audit a chargemaster to make certain that compliance concerns are met and that reimbursement is optimized. Many chargemaster policies and procedures must be developed to assure proper reimbursement and appropriate compliance.

This 90-minute session by expert speaker Duane C. Abbey, Ph.D. will answer various questions related to the chargemaster, including:

  • What is the method of balancing revenue optimization with maintaining compliance?
  • What kinds of policy decision must be made with the chargemaster?
  • Should there be written chargemaster policies and procedures?
  • Why are charges such a big deal?
  • What is the reason behind revenue codes being ambiguous sometimes?
  • How should supplies be handled?
  • What about drugs and injections?
  • What about nursing services?
  • Should the cost report be a point of concern?
  • Do we have different types of chargemaster audits?
  • What is the way clinical personnel may get involved in a chargemaster audit?
  • How should the chargemaster be adjusted for changes in payment systems?
  • Why is there so much concern about inflated charges from hospitals?

Prerequisites for Participating:  A general understanding of the chargemaster and the charge development process is required.

Session Agenda: 

  • Overview of the Chargemaster Form, Structure, Contents: Overview
    • Billing System Influence
    • Special Service Area Requirements
    • Chargemaster Interfaces
    • Pricing, Charge and Cost Report Issues
    • Payment Systems
      • DRGs
      • APCs
      • MPFS
      • Other
  • Chargemaster Compliance Concerns
    • Statutory
      • Medicare
      • Medicaid
    • Contractual
      • Private Payers
      • Types of Contracts and Payment
  • Chargemaster Review Process
    • Personnel – Team
    • Purpose of Audit
    • Type of Audit
    • Conduct of Audit
    • Results from Audit
  • Chargemaster Policies & Procedures – Judgment Metrics
    • Chargemaster Policy and Procedure Issues
    • Integrating Chargemaster Policies and Procedures with Other Areas Such as Billing and Utilization Review
  • Issues and Needed Changes for Increased APC Bundling
  • Special Situations – Example and Case Studies
  • Chargemaster Coordinator Action Steps

Session Highlights:

  • Review The Chargemaster As A Financial Tool
  • Understand how the Chargemaster affects reimbursement under different payment arrangements and contracts
  • Understand Statutory Compliance Surrounding the Chargemaster
  • Appreciate the Contractual Obligations That Hospitals Have Concerning the Setup and Use of the Chargemaster
  • Have A Systematic Process to Review and Evaluate the Chargemaster
  • Discuss The Many Compliance Concerns Surrounding the Chargemaster Including Development of Pricing and Charges
  • Realize the need to develop chargemaster policies and procedures
  • Appreciate the very different requirements that are created by various different third-party payers to code, bill and for the chargemaster
  • Understand how the Chargemaster affects and is affected by different payment systems including DRGs, APCs and MPFS
  • Understand changes in the chargemaster for currently evolving trends in payment systems such as APCs (Ambulatory Payment Classifications).
  • Understand the Chargemaster Interface to the Cost Reporting Process
  • Review Action Steps that Chargemaster Coordinators Can Take To Review the Chargemaster and Make Improvements

Who should attend?

Chargemaster Coordinators, Billing and Claims Generation Personnel, Compliance Personnel, Patient Financial Management Personnel, Cost Accounting Personnel, Cost Report Personnel, Financial Analysts, Managed Care Contract Personnel, Revenue Enhancement Personnel, Chief Financial Officers, Chief Compliance Officers, Financial Planners, Internal Audit Staff, Utilization Review Staff,  and All Other Hospital Personnel Interested in Pricing.

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

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