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Chargemaster Capabilities That Support RCM

As most of us in this field know, the chargemaster or charge description master (CDM) is a database at the core of not only the revenue cycle, but also the facility's bottom line. An accurate and current chargemaster is critical to revenue integrity. After all, 100% of patient revenue you generate involves the chargemaster. Let’s step through key ways your CDM solutions should support revenue integrity best practices.

New Rules, New CDM Demands

With the arrival of new price transparency rules and regulations, healthcare organizations will do well to examine their chargemaster management. The new rules have put a new spotlight on the data chargemasters contain and manage. It’s time to not only ensure that revenue items are accurate — but ensure charges are compliant AND competitive. The best practices of accurate coding and pricing, combined with automation tools, continue to hospitals’ best bet.

Technology Can Shoulder The Load

CDM management is typically a group effort, since the processes are organization-wide. One person or even one department cannot do it all. The latest technology however can simplify the immense amount of work. Chargemaster solutions maintain items in real time, ensuring compliance, and are key to clean claim submission.

Indispensable capabilities to look for in a CDM management solution include: visibility and management of all your charge data regardless of department (pharmacy, professional, supplies, etc); integrated change request workflows; reports on updated coding and billing regulation; benchmark data that shows a range of like facilities; and of course, a vendor with readily available client support.

Best Practice: Coding

Accurate coding is the bedrock for mid-cycle revenue best practices. An effective chargemaster management system will consume all of your coding data, and regularly check for accuracy against established and updated CPT codes.

The OIG states a compliant program has on-going auditing and monitoring. With a solution that is real-time, and concurrently checks coding, the facility has a key element of the compliance plan covered. Additionally, it’s important to continue end-of-year checks all the way through the beginning of the following year. Many of the next year’s CPT and HCPCS codes, as well as reimbursement rates, are released and updated through January. A high quality CDM management tool can do a massive amount of this work for you, and make the new year significantly less disruptive.

Best Practice: Charges

Once codes are accurate, it’s time to move on to charges. Revenue cycle leaders need to determine their chargeable services are competitive for the community they serve, and are consistent within their system. A superior CDM management tool will put all of this data in an easy-to-use format with all the key views at your fingertips.

Having clear and accurate pricing is integral to helping patients understand their healthcare costs and a requirement for the new price transparency rules. It’s another way good technology will help you manage your CDM and make compliance with the new guidelines less difficult.

Best Practices: Connecting With Clinical

With the twin components of codes and charges in good, accurate order, the chargemaster must also be used effectively on the clinical side. CDM-related education for clinical department managers and staff helps make sure everyone is on the same page and can prevent errors from occurring at the outset of care. This can be enhanced further with informatics that link documentation to charges through the chargemaster as this will ensure documentation is present prior to charge submission.

Choosing A CDM Solution to Sustain Best Practices

Making sure the chargemaster has updated codes, accurate charges, and good clinical connections can be a daunting undertaking when done with manual processes or outdated technology and content. Of course, this is why most facilities turn to automation. A CDM management technology solution can reduce your need for maintenance resources and decrease human error. An excellent automated tool will also be customizable to your needs and provide you with a number of reports tailored to the way you manage your chargemaster and revenue cycle.

So, to practice good chargemaster hygiene, you’ll want to train staff to identify potential issues AND look for the following significant capabilities in a tool:

  • The ability to consume your entire CDM and ancillary department files, providing you a clear view of all your data in one place.
  • Unlimited fee schedules uploaded in that same platform, allowing viewing and analysis from a single, easy-to-use dashboard.
  • A comprehensive view of your pharmacy, supply, professional, and hospital CDM analyses.
  • A simple and flexible workflow that is easily customizable to match your internal processes.
  • Real-time access to a knowledge base of regulatory content and compliance standards that are updated frequently.
  • An experienced team behind you, with expert personnel that is accessible when you need them.
  • Access to an audit trail, to allow hospital staff to view a history of CDM changes, giving them the ability to integrate data, reporting, and analytics for strategic planning and pricing.
  • Informative, automated alerts that will notify you anytime there are changes to regulations.

Your CDM Solution

With your chargemaster at the foundation of your facility’s revenue cycle, choosing and making full use of an up-to-date system is crucial. Especially in today's environment. In order to manage your CDM, maintain best practices, and stay compliant with new rules — a versatile and efficient software tool is your best solution.