In today’s healthcare environment, it’s difficult to maintain a profit, even in the absence of mistakes. With chargemaster errors, staying lucrative is nearly impossible. The chargemaster and its pricing lists are the foundation of any healthcare organization’s financial existence.
Accurate coding is essential for full payment. With coding errors, bills aren’t paid and millions of dollars in revenue from multiple payers are left on the table. Simple as that. To identify and correct problems in a chargemaster, it’s essential to periodically perform a comprehensive Chargemaster Review.
Whether performed internally or by a third party, a Chargemaster Review must be conducted with care and a close attention to detail. The following four considerations are a good place to start:
What is Your Goal?
Clearly define the goal of the Chargemaster Review and its scope before beginning. While most reviews will include reviews of pricing, CPT coding and revenue coding, there’s no reason to limit yourself. Expand the scope to include not only what’s in the chargemaster, but also how those charges are used. A Chargemaster Review can also include a Charge Capture Review. By clearly defining the goal of the Chargemaster Review, you can more accurately define the appropriate scope.
Is the Needed Data Available?
Once you have defined the goal and scope of the Chargemaster Review, consider what data is needed to get the job done. A comprehensive review will require far more than a copy of the chargemaster, even if it’s an internal review. Make sure all necessary data — which may include each department’s revenue and usage, item master and pharmacy formulary — are made available.
Is the Clinical Side Engaged?
Clinical engagement should be achieved early in the Chargemaster Review process. No matter who is conducting the review, they need to know how the clinical side is using chargemaster prices to support the hospital’s revenue goals. With clinical engagement, the Chargemaster Review can also serve as an opportunity to educate all departments about the importance of charge capture. A comprehensive Chargemaster Review with good clinical engagement can clearly and viscerally connect each department’s chargemaster practices to the overall financial health of the hospital.
Does the Review Lead to Obvious Next Steps?
Whether the hospital has selected a third-party vendor or is using an internal audit/compliance team, the Chargemaster Review must be conducted in a way that leads to action. The hospital must have a way to follow through and execute on the post-review recommendations. As is often the case, recommendations are easy to make but not always easy to accomplish. MedCom Solutions prides itself on being able to effectively fill this gap, between recommendations, implementation, and ongoing monitoring.
MedCom Solutions provides health facilities and health systems with a comprehensive Chargemaster Review, or a CDM Review, that ensures Chargemaster accuracy and delivers a comprehensive picture of the facilities’ current charging practices. We perform detailed, line-by-line analyses of both the information received from Charge Capture and the information submitted for billing to correct inaccurate charging practices and enhance long-term revenue. Our Chargemaster, Pricing, and Compliance solutions have yielded hundreds of millions in net revenue for healthcare providers across the country.
To learn more, check out our solutions, visit our homepage or contact us today!
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