Historically a Critical Access Hospital did not require CPT or HCPCS coding and was not subject to the Medicare National Correct Coding Edits however as of July 1st, 2018 all hospital types are now subject to NCCI edits which prevent improper payment by Medicare when incorrect code combinations are reported. This editing applies to services provided to the same beneficiary, on the same date of service, by the same provider. Reporting both codes will generally result in the denial of payment for one of the services. All other payors such as Medicaid and Blue Cross or Aetna (for example) do require CPT and HCPCS coding and therefore each Critical Access Hospital Chargemaster will contain the detail codes, which makes the facility obligated to follow the Medicare National Correct Coding and billing edits.

Comprehensive Chargemaster review based on a multi-layered approach of “comprehensive” services proven to maximize your revenue and compliance:

 
 

  • Comprehensive CDM Kick-off Call and CDM Presentation

  • Department Interviews (optional for onsite or off-site)

  • Chargemaster Review of CPT/HCPCS, Revenue Codes and associated descriptions for accuracy

  • Review of Chargemaster Revenue & Usage

  • Hospital pricing review against Medicare APC and Commercial Fee Schedules if requested

  • Pharmacy Dosage and NDC-to-HCPCS Review

  • Additional Revenue identified through missed or under-billed services, by department

  • Identification of price discrepancies for “like” services 

  • Charge Capture Review of 15 select, outpatient Medical Record encounter-to-Itemized Statement through UB04/HCFA 1500

  • Creation of Charge Capture Policy & Procedure Templates

  • Education Presentations based on findings for nursing use on Observation, Infusions & Injections, and Critical Care in the ER

  • Audit of facility ER, OR and Evaluation & Management levels and assistance in creating or updating leveling tools

  • Review of findings with staff that include a working Facility Action Plan for implementation use

  • One Year of Unlimited Questions to Your Consultant to ensure implementation success


Comprehensive CDM Kick-off Call and CDM Presentation 

 

  • Meeting with Core Staff (HIM, PFS, CFO, IT, CDM Coordinator) to determine specific issues within a department’s “charge capture process” that may require additional time and attention.

  • Provide a department wide Chargemaster Education Presentation to ensure that there is an understanding of the Chargemaster, the role that the managers play in the CDM Maintenance and the charge capture process as it relates to the facility.

  • Presentation of detailed findings and Facility Action Plan for successful implementation

Department Interviews (optional for onsite or off-site)

 



  • PFS, HIM, CNO, CDM Coordinator & IT to determine “front” and “back” end charge capture issues

  • Department manager and charge entry staff (if applicable) for services provided but not set up.



Chargemaster Review

 

  • Accuracy of CPT/HCPCS against the current Medicare Addendum B codes and descriptions

  • Review of Chargemaster Revenue & Usage for Under-billed and Over-billed services that may result in additional revenue or compliance issues

  • Revenue Codes assignment associated with the service, drug or supply based on the current Uniform Billing Editor 

  • Pharmacy Drug review of NDC-to-HCPCS for correct coding assignment of current codes and missing codes

  • Pharmacy dosage calculator based on hospital billing system and Medicare HCPCS code to ensure the dispense amount is accurately reflected in the final bill

  • Hospital pricing review against Medicare APC and Commercial Fee Schedules if requested

  • Pharmacy Dosage and NDC-to-HCPCS Review

  • Additional Revenue identified through missed or under-billed services, by department

  • Identification of price discrepancies for “like” services 

 

Charge Capture Review

 

  • Complete audit of 15 outpatient service encounters of various insurance types which are often found to have under-billed drug units or missing services or surgical supply HCPCS. The patient encounter/EMR is reviewed against the patient Itemized Statement to UB04 or HCFA 1500. Facilities may request a higher volume percentage of those departments experiencing insurance denials relative to CPT, HCPCS, Revenue Codes or Drug dosages. Types of encounters include:

 

  • Outpatient Blood Transfusion

  • Observation 

  • Radiology 

  • Obstetrics 

  • Emergency Room

  • Operating Room

  • Wound Care

  • Pain Clinic

  • PT/OT/ST

  • Oncology

  • Radiation Therapy

 
 
 
 

Creation of Charge Capture Policy & Procedure Templates

 

  • In many cases, facility or clinic clients do not have the necessary Policy & Procedure documents set up for departmental guidance for Chargemaster Maintenance. RIMR will assist in creating or updating your Policies and Procedures based on current Medicare and Chargemaster Best Practice Standards::

 

  • Standard Mark-Up rates for Services and Supplies

  • Daily Reconciliation for Departments

  • Inpatient Room Rate Policy

  • CDM Maintenance 

  • Billable Supply Policy

 
 
 
 

Education Presentations

 

  • Power Point education presentations are available to staff based on the Comprehensive review and educational needs of staff:

 

  • Patient Type (Observation)

  • Infusions & Injections

  • Critical Care in the ER

  • Chargemaster Basics (typically provided as part of the new hire onboarding for billers, coders, CDM Coordinators and nursing)

 
 
 
 

One Year of Unlimited Questions to Your Consultant

 

  • The hospital managers, PFS, HIM, CFO and CDM Coordinator may contact your consultant with questions relative to the Comprehensive Chargemaster findings.