Periodic Chargemaster Reviews Reduce Lost Revenue and Risk of Audit, Mitigating Incorrect Billing and Compliance Issues
- Written by Robin Zweifel
An out-of-date chargemaster can translate to lost charges, incorrect billing and submission of noncompliant claims, resulting in an increased risk of audit. In contrast, an up-to-date chargemaster enhances revenues, increases efficiency in the revenue cycle and reduces compliance risks associated with improper submission of claims.
Periodic line-by-line review of all CPT codes, pricing and revenue code mapping increases the accuracy of each claim submitted for reimbursement. However, to ensure complete capture of all billable charges, the review cannot be limited to analysis of the service code description and coding.
When you engage Panacea to provide a comprehensive chargemaster review, you receive the benefit of working with consulting experts who bring clinical and technical expertise to the table while conducting interactive interviews with your staff. Through detailed conversations with our experts and the educational focus of these interviews, you will expand the knowledge base of your clinical, technical, coding and billing staff regarding relevant coding and billing regulations. Additionally, Panacea utilizes its state-of-the-art CDMauditor.com technology during its CDM engagements and makes the software available to clients at no additional cost, allowing them to perform a three-month lookback to ensure that all changes have been made correctly – and to see if any new issues have arisen.
Meeting with department managers and technical staff to compare department test menus and services to the list of billable items on the chargemaster most likely will identify obsolete line items to be deactivated and the need to revise or add line items to represent current order entry options accurately. Our interviews involve clinical and technical staff, HIM coding representatives and billing and accounts receivable personnel in order to ensure identification of charge capture errors or missing charges, as well as improper billing units or improper use of modifiers. The process also includes a focused review of outpatient claims and supporting documentation, which highlights charge capture weaknesses – whether an invalid procedure link to a billable item in a system interface, or the need to provide staff education regarding appropriate manual entry of charges. With so many information systems now generating charges based on documentation input, it is absolutely necessary to validate that all coding has been linked to keystroke entry appropriately.
The next step toward ensuring that charge capture mechanisms are in sync with payer guidelines for reimbursement is analysis of the entire encounter, from point of order to receipt and posting of final payment.
Whether you engage Panacea to perform a CDM FlexAudit,™ (a one-time CDM analysis to identify priority issues), a service line analysis to resolve concerns related to a high-utilization/high-review department, or a comprehensive chargemaster analysis with documentation review, you will experience the outcomes of improved coding and billing compliance.
About the Author
Robin Zweifel, BS, MT(ASCP) is Vice President, Clinical Consulting Services – Chargemaster of Panacea. Robin’s area of expertise includes clinical laboratory and chargemaster management, as well as Infusion and Pharmacy regulatory compliance. She is lead on the development of Panacea’s CDMAuditor’s CDM Coding & Compliance Module and contributes to a number of publications and web-based products that help providers maintain regulatory compliance while ensuring positive revenue outcomes. Contact Robin at 800-252-1578 x3012 or firstname.lastname@example.org.