Transitioning from nurse to chargemaster coordinator

Wednesday, December 13, 2017

How does someone discover the niche of revenue integrity? For one nurse, all it took was a job posting at her facility.

After 23 years working as a gastroenterology nurse, Lois Nelson, RN, BS, CRCR, chargemaster coordinator at Mary Greeley Medical Center in Ames, Iowa, transitioned to the finance side of the hospital. For her, the transition was all about taking on a new challenge.

“When I looked at this job opening, they had not had a chargemaster coordinator before,” she says. “They had a person who was handling it, but it was only part of her job description. This gave me an opportunity to delve into what the role was, what the responsibilities were.”

Today, Nelson manages the chargemaster, chargeable items, and efficiency of the finance side of the hospital. She has been in the chargemaster role for four years now, as part of the accounting department.

While her facility doesn’t have a revenue integrity team per say, the clinical documentation improvement (CDI) and health information management (HIM) teams perform revenue integrity functions, such as annual pricing updates. In the last year, Nelson has been working on various projects, including meeting with the supply management team to better define job descriptions for the chargeable supplies.

“When new supplies are added, I need to investigate if that item is chargeable and to find a HCPCS code if there is one available. Like items need to be reviewed to assure compliance of chargeability according to a decision tree,” she says.

Nelson also performs annual reviews of departments such as lab, radiology, and cardiopulmonary to ensure compliance. 

To ensure everyone is on the same page, the business team established a monthly revenue cycle committee meeting for its department, as well as a multidepartment charge committee meeting. The latter of which is a big undertaking.

Facilitated across several different departments, 16 charge committees from Epic to HIM to CDI come together to meet biannually to discuss line items in the chargemaster and areas of improvement.

Nelson leads the staff in reviewing three months of reimbursement. They then discuss any new procedures which may be needed to follow-up on proper coding and obtaining full reimbursement.

This meeting also involves reviewing charge capture processes, Medicare informants, work queues, bedside procedures, and revenue and usage of items. If changes are made, someone is assigned the action and follow up at the next meeting, she says.

When Nelson isn’t planning meetings, she’s monitoring the chargemaster. A few projects underway include getting the new codes in place and updating E/M codes.

Nelson finds success in working with the supply management team. It’s easier to determine what’s chargeable versus nonchargeable, she says.

To find out more about the functions that makeup revenue integrity, read the Core Functions of Revenue Integrity.



Found in Categories: 
Program Management, Revenue Integrity