Getting a handle on fee schedule charges: A look into systemwide revenue integrity

Wednesday, June 13, 2018

As revenue integrity departments grow in prominence, some organizations will look to expand the benefits beyond the hospital setting to set systemwide processes and goals. Revenue integrity professionals could find themselves presented with the opportunity to venture into new territory on the physician practice side of a health system. Although that will offer the chance to explore, learn, and improve the organization, it can also be a daunting prospect. It’s a whole different reimbursement landscape, and revenue integrity professionals who know their way around hospital-based reimbursement will need to forge a new path.

Nancy Woods, chargemaster analyst at Norton Healthcare in Louisville, Kentucky, found herself in a similar situation when she was asked to take on managing charges for the physician and ambulatory fee schedules in addition to the hospital chargemaster. Woods is a revenue integrity professional on the hospital side and although her training and experience applied to her new duties, she realized she needed to truly dig into the nuances of physician reimbursement to do her best work.

“The physician side was totally new to me, so understanding the CPT® codes, how they are used, and how the charging system is set up was important,” she says. “I didn’t think it would be that much different because we are all one system, but it is different.”

Fortunately, Woods was able to turn to resources in her organization as she ramped up. The director of revenue integrity for physician practices worked with Woods to train her on the ins and outs of that side of revenue integrity. Although Woods is continuously learning, she found that she was able to pick up the information and quickly apply it, growing her role on the physician side of the organization. At first, Woods’ primary responsibility was pricing charges and maintaining the multiple fee schedules, but as she gained experience her role expanded to handling work queues including zero-dollar work queues.

Woods values the opportunity to learn and challenge herself and to put her new knowledge to work. One of her current projects involves streamlining and automating the charge request system on the physician side to simulate the automated system used for requesting and updating the hospital chargemaster. Currently, a more manual system is used to request a new charge be added to the fee schedule or to make an update to an existing charge. Woods believes a manual system is less than optimal because it leaves more room for error. She’s working with her organization’s information systems team to develop an automated online form that physician practice can use to request additions or changes to the fee schedule. The new process will also allow Woods to ensure that more detailed information is included in each charge description beyond the basics of CPT code and price.