Reasons For Good Chargemaster Maintenance


Medical Billing Training: Five reasons for good Chargemaster maintenance

Obviously, reimbursement for many outpatient services are driven by the charge description master. It's not the only factor. We have to have the documentation in the medical record. We have to have the ICD-9 codes on the cases of appropriately coded, the surgery codes from IHM. Read the following expert guidance presented by our speaker in a health system conference.

But reimbursement for many of services in the outpatient setting are driven by the Chargemaster. And the Chargemaster impacts all services. We have revenue codes that can impact our outpatient reimbursement.

Obviously, the CPT codes usually for those non-surgical services are driven by the Chargemaster. So reimbursement, that's one reason that we want to make sure our Chargemaster is correct. And that's probably the reason that comes to everybody’s mind when you think about the Chargemaster. That's not the only one.

Secondly, charges for all our services are driven by the charge description master. So our charges, regardless of whether the reimbursement might be driven are charges for all service are driven by the CDM.

And if we don’t do a good job of maintaining our charge description master correctly, it's going to impact all levels of reimbursement. It's going to impact our cost report. It's going to impact outlier potential. So a lot of reasons for maintaining a good Chargemaster.

Another reason is if it's not good, if it doesn’t have the right information in it, then all of your data is going to be eschewed. And if your data is eschewed, any type of reporting that you do from that Chargemaster data is not going to be valid.

And hospitals run, hopefully run a lot of reports so that you can manage the operations of the hospital. Well, any of those reports that come from a Chargemaster, if you have a lot of junk in your Chargemaster, then the reports aren't going to be worth very much for you. They're not going to tell you good information. (Know more; visit our Health system conference page)

Now, another reason kind of looking at the antithesis of the reimbursement one, there are compliance risks. There are physician billing compliance risks involved in every line item filled for a CDM.

So if you have let's say drugs on your Chargemaster which you're going to, so if you have pharmaceuticals billed and you have the wrong charging elements, we're going to talk about units after a while, or supplies if you're using a covered HCPCS code for supply when that's the wrong code, when it's the code that should be bundled, then you have physician billing compliance risk built into your Chargemaster. And we absolutely want to make sure that we clean those up.

And lastly, the most important reason for having good Chargemaster maintenance is it's going to save your facility time and money in the long run. It's going to get the right level of reimbursement in your facility. It's going to make sure that you are at the lowest level risk possible at least from the Chargemaster’s perspective. You're going to have accurate information being fed into your cost report. You're going to have good reporting capabilities. It will save you time and money in the long run. So it's a good use of resource.

Now, it does cost resources to maintain a good Chargemaster whether you have software supported, Chargemaster maintenance or you have individuals in your facility maintaining the Chargemaster, it takes a lot of your time. It takes money to do it now.

But those resources have to be extended. You simply must maintain a Chargemaster. You could do a cost benefit analysis to support the right level of charge description master maintenance that's necessary.

Think about this. If you have a good clean Chargemaster fewer of your claims are going to be rejected at the point of billing for edits. If there's something that can be corrected in the Chargemaster and it wouldn't cause an edit to occur at the point of billing, that's going to save money and time.

It's also going to be at the right level of expertise. Let's say you have a problem in your Chargemaster that creates an edit at the point of billing. So the person doing the billing gets this edit in front of them.

Now, what are they tasked to do? What are their responsibilities? Do they have to send it back to someone to say, “What should I do with this? How should I clean this claim to get it to process correctly? Do they make the decision? And if they make the decision, on what are they facing that decision? Is it the right decision? And if they decide how to clean that claim, will the same error occur on another claim?”

So getting it clean upstream in the revenue cycle, much better way to handle it, much more cost effective. So it's worth the time that you have to devote to good Chargemaster maintenance.

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