You are a financial analyst that is part of a chargemaster maintenance team. In the absence of the previous chargemaster coordinator, you are now responsible for chargemaster audits and maintenance process. You discover that chargemaster maintenance is three months behind. You quickly determine that you will not be able to complete chargemaster tasks in addition to your other job responsibilities. After reviewing research and literature on best practices for chargemaster management (i.e. updating codes, automation, audits, set charges, etc.), you decide to create a process for chargemaster maintenance. Present your findings and process in a proposal to the maintenance team.
Assignment Instructions
For this assignment, you are to:
• Examine the selection and development of applications and processes for chargemaster and claims management.
• Compare examples that emphasize the methods for controlling cost by reducing errors.
In a written proposal:
- Explain/ summarize the importance of claims management and chargemaster maintenance.
- a. Identify at least three best practices.
b. Describe why they should be included in your chargemaster maintenance process.
- Create a process for chargemaster maintenance.
Provide a visual/graphic display of your process.
Describe each step and/or component of the process.
Full Answer Section
Chargemaster Maintenance: Maintaining the chargemaster's accuracy, completeness, and compliance is paramount for optimal claims management. This necessitates proactive and ongoing updates, addressing changes like:
- New codes and rates: Incorporating updates from CMS and payers to avoid erroneous billing and compliance issues.
- Inventory and service modifications: Adding or removing supplies, medications, and procedures to reflect service offerings.
- Contractual adjustments: Adapting pricing based on negotiated rates with payer contracts.
Neglecting chargemaster maintenance throws the entire revenue cycle into disarray. Incorrect charges inflate claims, triggering denials and potentially audits. Outdated codes can lead to underbilling and lost revenue. Inaccurate pricing undermines contractual obligations and erodes trust with payers.
2. Best Practices for Efficient Chargemaster Maintenance
Given the crucial role of chargemaster accuracy, incorporating best practices is vital:
2.a. Automation and Standardization:
- Automated price updates: Leverage software to automatically integrate updates from payer fee schedules and regulatory databases, minimizing manual effort and human error.
- Standardized coding protocols: Implement clear guidelines for assigning and updating codes across departments, ensuring consistency and compliance.
- Workflow automation: Utilize technology to automate tasks like data entry, discrepancy identification, and approval routing, saving time and boosting efficiency.
2.b. Regular Audits and Reviews:
- Periodic audits: Conduct comprehensive audits at predetermined intervals to identify and rectify coding errors, outdated pricing, and missing entries.
- Departmental reviews: Schedule regular reviews with service departments to update information for their respective areas, ensuring chargemaster data reflects actual service offerings and pricing.
- Claims analysis: Leverage claims data to identify billing discrepancies and potential chargemaster inaccuracies, prompting necessary updates.
2.c. Collaboration and Transparency:
- Team-based approach: Foster collaboration between the chargemaster team, billing department, and service providers to ensure everyone is informed and involved in maintaining accuracy.
- Training and education: Continuously train staff on coding systems, chargemaster updates, and best practices to keep everyone equipped with the necessary knowledge.
- Clear communication: Establish transparent communication channels to promptly address concerns, report discrepancies, and share updates among stakeholders.
Sample Answer
. The Intertwined Significance of Claims Management and Chargemaster Maintenance
Claims Management: The lifeblood of healthcare revenue, claims management ensures accurate billing and efficient reimbursement from payers. Every claim submitted originates from the chargemaster, a comprehensive database of services, supplies, and medications with associated prices. Inaccurate or outdated chargemaster entries lead to rejected claims, delayed reimbursements, and ultimately, revenue leakage.