Chargemaster Checkups Capture Lost Revenue

Editor’s note: This piece is based on Karen Minich-Pourshadi’s July 6 online column, “Is It Time For A Chargemaster Check-Up?” To see the column, click here.

Finance leaders are charged with being aware of more than where every penny goes—they must also be keenly aware of how their billing activities leave them open to compliance scrutiny. Sometimes that means taking a magnifying glass to areas like the chargemaster to see if the hospital is slipping off track, and if so, revamping workflow processes, adding new technology to unify disparate systems, and retraining staff. Such was the case for Intermountain Healthcare.

The Salt Lake City nonprofit system includes hospitals, surgery centers, physicians, clinics, and home care and hospice providers and serves Utah and southeastern Idaho. With approximately 2,500 beds, 23 hospitals, and 140 medical clinics, there are ample opportunities for revenue generation, but there’s also plenty of room for billing inconsistencies (and, therefore, compliance woes) if charge tickets aren’t done correctly.

Last year, Todd Craghead, vice president of revenue cycle at Intermountain, began the process of trying to bring the chargemaster in line for all the facilities in the system. Though many hospitals are a part of the system, they were, for the most part, operating independently—and that meant independent back-office processes and different approaches to billing. The system wanted to unite not only to improve the billing process, but to take better advantage of its size.

“While we knew there might be a fair amount of money being left on the table, our motivation to unite was based on a review that we had done which highlighted a number of areas of compliance risk for how we were capturing and charging for items—we needed corporate standardization and process efficiency, and a common tool to help us bring things together,” he said.

To do this, Craghead and his team decided to look for a software program that would streamline and make their charge capture process consistent. “We have revenue folks doing reviews already, but we saw a lot of variation and we were concerned. We wanted to be consistent,” said Craghead.