Avoid Edits When Billing Rules Change


Medical Billing Training: Avoid Increased Edits Once Billing Rules Change

You may know that chargemasters are challenging, and can be a direct or indirect target for both government programs and private third-party payers. That’s why your hospital requires building a systematic and organized process to audit a chargemaster — particularly if it has to remain financially viable. Read this expert medical billing training article for more.

You have outpatient code editor changes that come out quarterly along with the correct coding initiative changes. That as well as all the other memorandum that we get not just from Medicare but probably primary for Medicare to saying, “Okay, now this changes.” So make sure you correct it in your billing system.

So take a look at now is how can you avoid proactively some of those volume shifts so we don’t have quite as many edits when billing rules change. Here are some of the medical billing training pointers you should follow;

First of all, if you're responsible for the charge description maintenance, you should join your payer listserv. Medicare and several other payers have listservs where you can sign up to be allotted to any changes that are coming up.

If you're already a part of these listservs, you know you usually get something everyday or perhaps even a couple of times a day. So join your payer listservs. Seek out any payers that might have those.

Enough good reason to do this is as you're meeting with your committee members, you can bring both most recent listserv informational nuggets to those meetings and discuss them. And it comes from the official resources.

The payer is saying this is what we're going to do or this is what want you to do. So rather than reading a third party’s interpretation, track it as directly as possible from the horse’s mouth.

Now you also want to listen to the payer audio conference. They very often will have audio conferences on these changes and give you an opportunity to ask questions. So sign up for those or have someone in your facility sing up for those and take copious notes join them.

Ask questions. You might want to prep for the audio conference with your committee or your colleagues on the charge description master if you're able to ask those questions.

Then the next one, you want to track the federal register changes to the Medicare payment system for especially outpatient perspective payment system. That's the one that usually impacts the Chargemaster the most.

And we know that the outpatient perspective payment system changes. You want to see what changes are coming out. Then you obviously must look at the final rule, okay. We said we were going to do this. This is the part that we're actually going to implement.

The reason why you want to leave the proposed changes is you want to start seeing okay, how will this impact us? You want to make sure that you're synthesizing the information as you read it. And sympathizing means is as you read a guideline change within that federal register, think in your mind how would that impact us, what changes would we need to implement, what are the potential outcomes of this.

So you want to make sure that you completely understand not just the rule but how it would work in your system from the point of service or even the point of registration to the point of accounts receivable management.

So think through it at a deeper level than just reading the medical billing guideline for your own benefit. Really try to think through the entire impact of it.

Medical Billing Training Tip: Now, if you need to make changes based on the federal register, do not physically make changes on the proposed rule. Wait for the final rule. History tells us that not everything that’s in the proposed rule necessarily ends up in the final rule. So we don’t want to waste any time implementing changes that may or may not be necessary.

You certainly might have to put them on queue and be ready for the change but don’t activate them. Just do that based on the final changes or final rule or else, you're going to be spending a lot of time trying to retract what you've already done.

So you want to test prior to making any changes in your Chargemaster. If you update a Chargemaster line item, run some dummy claims through. Check the charge slip system. Make sure from beginning to end, it works. Instead of having to change, you may create problems elsewhere.

Make sure it's clean and it works well. And that's why test through the entire revenue cycle. There's pieces of it that makes sense. If you make a change to the Chargemaster and let's say that it's in the laboratory section, well it's not just the Chargemaster just that feedback to the automated paper charging system that lab uses.

Well maybe you say yes, that's part of the medical billing process. When change is made to the Chargemaster, a change is automatically made change as appropriate to the charge slip. That's great. Are there any education needs necessary at that point? In other words, do you need to go to lab and see who the charging person is and make sure that they understand the change that they're aware of it and they know how to use it.

Do you alert anyone downstream? Perhaps that accounts receivable management that we made this change so, you know, there's a different expectation from a claims processing perspective. Just make sure that you make it clean and make it fully integrated.

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