Chargemaster and Charge Capture

Reach your destination by planning for revenue integrity success.

A proactive approach to denials is based on looking for opportunities to address and mitigate issues before claim submission.

Q: How do we to handle charges for donor-related services when the donor is an unsuccessful match? Should the charges for services provided to a potential donor who is an unsuccessful match also be included on the transplant recipient claim or should they be adjusted and just included on the cost report?

CMS is weighing an expansion of the hospital outpatient department prior authorization program, changes to 340B reimbursement in the wake of the Supreme Court’s decision, and alternative rate setting data among other proposals in the 2023 Outpatient Prospective Payment System (OPPS) proposed rule.

Focus on the people and processes that make revenue integrity work.

Anna Santoro, MBA, CCS, CCS-P, RCC, CHRI, shared three steps to a proactive revenue integrity department.

Consider how CMS’ proposed changes could affect reimbursement and revenue integrity operations.

Apply these tips to reduce and prevent common denials due to medical necessity, the three-day payment window, and more.

Rosemary Holliday, BA, MHA, looks at how to use data to improve chargemaster management.

NAHRI Advisory Board member Jugna Shah, MPH, CHRI, president of Nimitt Consulting, Inc., in Spicer, Minnesota, discusses how advocating for fair reimbursement and payment systems and raising awareness of the rules governing hospital pricing is fundamental to revenue integrity.