by Danelle Kelly, r.n., cpc, cpch
DJ Kelly & Associates, Inc.
Chargemaster review, do it yourself or hire out. Which is better for your facility?
The answer is probably both!
Have a reputable company do a major chargemaster review one year and then internally do the next one or two yearly updates, followed again with an outside review. Just be sure that no matter who is doing the review, they know what to do. Don’t be swayed by big name companies or great prices by the little companies.
The accuracy of your CPT & HCPCS coding has taken on more significance since the onset of the Outpatient Prospective Payment System (OPPS). Those codes represent the majority of your hospital’s Medicare outpatient reimbursement. Coding errors can lead to under reimbursement as well as overpayments that require self reporting and paybacks or refunds to payors—especially the Medicare and Medicaid programs.
Look for companies that:
- Have experienced and qualified staff to perform the review.
- Are willing to provide complete references that you spend the time to call.
- Want to examine the entire chargemaster and who want to meet with your managers in-person to discuss the exact procedures that are performed.
- Identify all the codes for each department that are not currently in your Charge Description Master (CDM) to see if they should be!
- Sort your chargemaster in CPT code order to look for like items in various departments for description, revenue code and pricing comparisons. Make those items consistent throughout the hospital.
- Provide ongoing monthly support (may be an additional fee).
- Will identify the problematic areas, suggest what changes are required and above all.
- Provide the regulatory documentation from CMS and others that supports their statements.
Steer clear of companies that:
- Do the entire review via email and the internet—do you really want just a computer match of your CPT, HCPCS and Revenue Codes without anyone talking to the departments?
- Talk more about maximizing your reimbursement rather than ensuring the accuracy of the codes.
- Won’t provide the documentation that supports their revisions.
Require every department management to actively participate in his or her cost center’s review and have the most current Revenue & Usage Report available for each department to refer to when deciding to deactivate codes. Bring technical staff to the meeting if management is unfamiliar with the procedures performed. Request the departments bring paper charge tickets or copies of charge screens and compare them to the actual line items in the department’s CDM. Take notes of what was discussed.
Most charge descriptions are limited to 25-30 character spaces for what appears on the itemized bill, whereas the departments have 60 to 80 character spaces for descriptions on the charge screens. This disparity has led to some unique descriptions on bills that bear no resemblance to what the department sees. Make sure they truly are the same procedure or item.
Due to the specificity of Pass-Through items for Medicare, allow those departments more time to identify the items meeting the criteria. They may need to provide your finance department with the individual costs so they can be marked up accordingly. Surgery, cardiac cath lab, and central supply have the highest volume of Pass-Throughs. Vendors selling the items frequently have the HCPCS codes available in a format either specific to your facility or as a list of their inventory.
Nuclear Medicine Isotopes and pharmacy pass-throughs must be billed in the dosages determined by Medicare rather than the doses they are typically dispensed.
After the on-site meetings, have each department review their section of the report when it arrives for errors and omissions.
(Next issue of Coding Clinic for HCPCS: Part II: What to do next.)