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Charged Up About Chargemaster Automation



If there’s one area you cannot afford to take your eyes off, it’s the chargemaster. With every revenue transaction funneling through it, the chargemaster has the potential to bring in or cost your hospital millions of dollars. Knowing that, I have to ask, why is it that so many hospitals still use a manual process when an automated one is really a time and money-saver?



2 comments on "Charged Up About Chargemaster Automation"
Michael (11/1/2010 at 6:00 PM)

Couldn't agree more Jill. The software from Craneware is probably the best solution to automate how a Provider uncovers potential gaps in their CDM, however I'm not certain any Provider would use the software exclusively to add charges unless they've done their due diligence of the operation to determine the validity of what the software found. I believe the Craneware software also helps identify trends and revenue gaps by inspecting claims as well as the links between supply chain spend and reimbursement. In these cases - I suspect the software is only automating the process of finding the potential gaps and missing links. It's up to the Providers' Revenue Integrity team to resolve any issues and fix the gaps, but their job is now spent fixing and not trying to find needles in a haystack. Software is only as good as the sustainable process build around the solution.
Jill R (11/1/2010 at 2:53 PM)

Let me start off by saying Craneware is a great product and worthwhile investment, however, Providers need to use some discretion when adding charges that may be all-inclusive or perceived as unbundled. While it may appear that there is greater potential for reimbursement, indeed you may be increasing your potential for denials, thus unrealistically inflating your AR, and expected Reimbursement. One of the modules Craneware offers is a product that looks at charging patterns nationwide and tells you, for example "75% of providers who charged for X, also billed for Y and Z". While this may invaluable for those whose CDMs are lacking in the appropriate macros, others may just be padding their claims with non-payable charges and engaging (unwittingly) in non-compliant billing practices, putting themselves at risk possibly for fraud/abuse investigation. I would use a GREAT deal of caution with this product. Just because 75% of hospitals do it, does NOT mean they are doing it right....as the RAC audits have proven. As with everything, buyer beware, if it sounds too good to be true, it probably is. I am in no way suggesting that it is better to leave money on the table, far from it, just that you use some common sense and in all things, do what is right.......that's why it's called Revenue INTEGRITY.