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Is It Time For A Chargemaster Check-Up?

 |  By kminich-pourshadi@healthleadersmedia.com  
   July 06, 2010

Financial 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.

Salt Lake City's Intermountain Healthcare is a nonprofit system of hospitals, surgery centers, doctors, clinics, and homecare & hospice providers that 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 Intermountain's chargemaster in line for all the facilities in the system. Though many hospitals are a part of the system, 23 of them were still, 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 their 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 to 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.

Though they had created charts payables for particular service lines, over time extra information was seeping into the tables and they continued to add different charge codes. "The chargemaster had become less useful, and we were using that to measure productivity statistics. So if we used the charging mechanisms we had to do more on the back end to resolve things that couldn't be billed but were being dropped onto bills," he said.

In their effort to resolve this inconsistency, they looked for vendor software that could help. They underwent a vendor review process, and after nine months, Intermountain selected Craneware, Inc.'s Chargemaster Tool Kit.

"With it we are now able to manage the request process and we can track where things are and who we are waiting on. We also have other tools that allow us to review codes, but the real difference for us has been managing the workflow and our chargemaster," he noted.

Over the next couple of years, Craghead expects that Intermountain will also see money that was left on the table find its way back into the hospital's coffers, but the need to get the chargemaster in order this year wasn't about that. While return on investment is always the goal for financial leaders, it's easy to forget that ROI can come in shapes other than dollar signs.

A periodic chargemaster review can help your facility systematically verify that the correct HCPCS and CPT codes are assigned to each line-item. It ensures your departments have a complete array of codes to report all services provided, and that all chargemaster line-items are compliantly reported to assure accuracy and reduce the effort necessary for maintenance. Now that's an ROI that any financial leader should be able to get behind.

Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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