About RIMR Chargemaster Reviews
The chargemaster is the very heart of the revenue cycle that can “make” or “break” the financial bottom line of any hospital or clinic. The quickly expanding role of the charge description master (CDM) has made maintaining it critical to financial success and a hospital’s continued compliance with regulations. It fulfills many needs as a revenue generator, productivity tracker, base for negotiating payer contracts, a tool for keeping abreast of competitors’ services, and, increasingly, a way to interact with patients through price estimation. Quarterly and annual coding updates put our facilities at increased risk of noncompliance with Medicare regulations, inaccurate or incomplete coding, increased claim edits and denials, potential loss of revenue, overpayment, and underpayment.
Because comprehensive chargemasters can have thousands of items, maintaining them manually requires an enormous amount of time, research, and vigilance. In a manual environment, the issues that arise from inaccuracies in the CDM are often discovered after claims submission. They are usually not reported to CDM personnel to update the Chargemaster to prevent a recurrence. Since CDMs are used to generate all patient charges, minor errors add up quickly in the form of compliance risk, rework related to edits and denials, and potentially lost revenue.
CDM maintenance will ensure compliance with regulatory requirements, minimize the risk of non-compliance and government audits, and minimize claim edits and denials due to coding errors. Facilities can confidently rely on the CDM data to monitor the cost of care and compile cost accounting data. To perform these tasks well, each element of the CDM must be current, accurate, and complete.
As part of the RIMR Comprehensive Chargemaster review, we will provide a multi-layered examination of your Chargemaster and one year of Revenue and Usage, Charge Capture review of 15 outpatient medical record encounters with associated Itemized Statement and UB04/HCFA1500, as well as department manager interviews to determine if services are being provided that are not currently set up in the Chargemaster. Additional revenue is also identified through missed charges or under-billing, quantified based on Medicare’s reimbursement rates.
We offer a variety of Charge Capture services for clinics and hospitals of all types, tailored to meet your specific needs; including Desktop (Off-site) Chargemaster Review, Comprehensive Chargemaster Reviews (on or off-site), Charge Capture Coding Reviews, Pricing Analysis, Pharmacy NDC-to-HCPCS, and Dosage Unit Reviews as well as Educational Webinars on Chargemaster Staff Education, Observation and Bedside Service Charge Capture, Nursing Infusion & Injections and Emergency Room Critical Care Charge Capture.
Our consultants are results-driven healthcare professionals with over 28 years of experience and expertise in all aspects of the revenue cycle—precisely that of Chargemaster consulting, Outpatient Coding & Auditing, Revenue Integrity Management, and identifying improvement opportunities in cash collections, compliance, Policy Writing, Chart Auditing, and process improvement for Hospitals, Physician Clinics, Long Term Care facilities, Critical Access Hospitals, and Rural Healthcare Clinics.
Examples of Additional Revenue often found:
Outpatient bedside services such as infusions and Injections (provided during Observation)
Under-billed CPR
Trauma Activation
Pain Blocks provided during outpatient orthopedic surgery
Outpatient Antipartum visit Facility Evaluation & Management levels
Our Comprehensive Chargemaster Reviews ensure that your Revenue Cycle functions to the highest capacity for maximum revenue and compliance. Our goal is to tailor our services to your specific needs. The services provided are offered with either on-site or off-site department interviews followed by a presentation of findings.
Contact us today to discuss the future success of your facility.