Say yes to chargemaster success

By Mark Boudreaux 

Your chargemaster (CDM) is the source of truth that reflects all costs and feeds all billings, and it needs to facilitate accurate charging and defensible pricing to promote a complete, accurate and compliant chargemaster. 

Accuracy is key to bill patients correctly, ensure compliance with Medicare and achieve optimal revenue. And, managing the chargemaster requires regular maintenance -- between quarterly regulatory updates and frequent service modifications, content can change daily.

How do you maintain a healthy CDM?

The integrity of your chargemaster depends on the completeness of the chargemaster codes and if they meet government regulations. Having a dedicated team and documented processes to ensure that everything you bill for is entered into the CDM and that the pricing is up to date is critical. Remember, you can’t charge the patient for a service, supply or drug that’s missing from the chargemaster. Having missing items or services in your chargemaster translates to lost dollars which negatively impact the health and performance of your revenue cycle. Additionally, it’s also important to know what items should not be chargeable. Non-chargeable items that accidentally slip onto a patient’s bill will result in a compliance violation.

Who is responsible for maintaining the CDM?

It’s usually up to the staff to interpret the new regulations and input new items. The process is labor intensive and requires the successful navigation of the Centers for Medicare and Medicaid Services (CMS) website. A more effective approach to maintenance would be to utilize technology to help automate and improve the updating of the CDM.

How to choose a chargemaster service?

When selecting a chargemaster service, ask if their capabilities review 100 percent of CDM items, including patient observation and other soft code charges. This is a crucial question because the number of lines in the Healthcare Common Procedure Coding System (HCPCS), authored by Medicare and the Blue Cross Blue Shield Association, represent not even half of the items found in a typical CDM. The other codes can represent a variety of line items that don’t have a Current Procedural Terminology (CPT) HCPCS code and, if the items aren’t set up properly, they could go unbilled.

Ask if they can work with all the leading electronic healthcare record (EHR) systems and can they easily integrate with existing patient accounting systems.

How much revenue loss are we talking?

While it varies among organizations, lost revenue can run into the millions. In one instance, nThrive worked with a healthcare organization to resolve missing CDM items and ineffective charge capture. We helped to develop a formal process to identify key roles and duties of the clinical and medical coding staff, which, once corrected, began returning an average of $500,000 – $600,000 in net revenue per quarter or approximately $2 million annually. nThrive CDM technology is vendor agnostic, which makes it possible to work within one tool to eliminate dual entries.

nThrive

nThrive, a leading provider of healthcare revenue cycle management technology solutions, recently launched a state-of-the-art, cloud-based charge description master (CDM) solution for modern EHRs, CDM Management. The web-based platform covers hospital and professional charge items for the entire chargemaster to help drive system-wide standardization to support optimal charge and pricing integrity. Built from the ground up, it supports dynamic data models within today’s top electronic health record (EHR) systems. Designed to provide an intuitive user experience and simplify data consumption, the native data views allow for easy and quick adoption. Coupled with improved data visibility of charge code to location-specific coding, fee schedules, shell code linkages, cost center association, and revenue and usage, CDM Management will help to ensure accurate, complete and compliant charging. If you’re ready to expedite effective decision making Contact nThrive for a demo.

Mark Boudreaux, Director Product Management