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