Year-End Chargemaster Updates: How to Create a Strategic Plan

Like nearly all endeavors, successful chargemaster year-ends begin with a great plan. Put the plan into place, access data for updates, and use job aids and your CDM software to make it happen. Let’s first review the pre-planning steps...

Pre-Work

Setting the Foundation for Success

CDM maintenance is not an ad hoc event, but rather a mainstay for a successful compliance program. Make sure policies are in place that define key stakeholders, roles and responsibilities, resources, and source authority. There are also several key procedures to supplement those policies:

• Ensure timelines and milestones are included
• Ensure appropriate data sources are available in a timely fashion — you want to make sure to get the data into your technology very quickly once it’s published.
• Recommendations for clinical staff education on yearly and quarterly maintenance tasks
• Contact information of CDM personnel for questions

How to Manage? Job Aids to the Rescue

The importance of job aids can’t be overstated. They provide specific, easy-to-use guidance to supplement the procedures. Job aids spell out detailed step-by-step instructions for clinical leaders to review department charges.

It may be that the review is not something your leaders are used to doing — having a clear-cut job aid will help them get through the process more easily. Keep in mind that those on the reimbursement side may use terminology that's unfamiliar to the clinical leaders, so defining that terminology is often helpful.

Job aids should provide plain English definitions throughout, so everyone understands and is on the same page during discussions. In addition to review instructions and definitions, job aids also:

• Provide specifics on how to access data required to perform tasks
• Provide sample timelines and checklists
• Ensure all clinical stakeholders have specific guidance they can follow in order to be successful
• Should be prevalent in most areas of the facility, as supplemental to policies and procedures

Take Full Advantage of Your Intranet

Many facilities create their own secure intranet site to house all of this information. It’s an excellent idea to have one place where everything necessary to undergo this project is located. The site should house:

• Policy and procedures
• Checklists
• Meeting dates and minutes
• Timelines and milestones
• Deadlines
• Contact information for if questions arise

It’s also useful if this information storehouse has the ability to set reminders in your internal calendar system so everyone involved can stay on track.

An ideal setup also would have folders by department so each department can review what was done in the prior year as a template. This is especially helpful from the clinical perspective so clinicians are not bombarded with information that's not relevant to their area.

If you use VitalCDM, all the reference documents and the agenda are right inside the tool. When you open the main landing page, there’s a dashboard at the bottom. From the dashboard, you can pull the agenda, the code update file to identify changes, and all the supporting documentation. This includes a list of added, changed, and deleted CPT codes each year. If you use something other than VitalCDM to manage your chargemaster, ask your vendor if there are similar functions and resources.

Putting the Plan in Place

Before getting started on this project, you’ll want to consider the Who, What, Where, and When.

Start With Who

There are many “whos” to determine before you get started. And believe it or not, we have found facilities where the staff listings had not been updated in five years. Some of the folks identified didn’t even work there anymore.

Start by determining:

• Who should be on the team...
• Who is going to lead...
• Who will the team interact with...
• Who are the leaders in each clinical department that will be pulled into the discussions
  

Determine and Include Key Stakeholders

Depending on the size of your facility, these are the most prevalent stakeholders:

• Chargemaster Team
• Reimbursement / Finance
• Revenue Integrity
• Patient Financial Services
• Clinical Leaders
• Revenue Cycle Leaders
• Internal Audit
• IT / Clinical Systems
• Financial / Clinical Education
• Managed Care Contracting*

*Including managed care contracting is key to setting up the chargemaster to accommodate the way your facility is contracted to get paid. Keeping them in the mix is vital to proper reimbursement.

The What

As part of a chargemaster year-end update, determine:

• What the team will do
• What are the expected outcomes
• What data / information is needed
• What tasks each team-member will perform

Much of the data will be housed in VitalCDM, but you may also need information about department directors and the contacts involved from other departments.

What Are the Objectives and Deliverables?

State your objectives upfront and define the deliverables. Identify needs, define actions, assign tasks, define the escalation process, and consider PMO involvement. Knowing these expectations in advance, and setting it all up at the beginning, will help ensure the project goes smoothly.

The Where

You’ll need to assess and agree where you’re getting the data, and where the changes need to be applied. If you're using VitalCDM, most of the data is right inside the system. You’ll be able to obtain the needed CPT/HCPCS update data and reference documents in the dashboard.

Where Will Changes Be Made and Stored?

It’s often not just the chargemaster that needs updating — the order entry system, radiology, lab system, and other ancillary systems may require updates, too. Consider where all this documentation will be stored. One big folder? Organized by department so as not to overwhelm clinical staff? Decide in advance to ease the process. Then figure out where to store this workflow so it becomes a standardized documentation.

And the When

Decide when the project should start and when milestones should be reached. Project kickoff and general timelines work well when they’re a structured format that can be used from year to year. Identify key milestone events such as code release dates and actual availability of those releases.

When Should the Project End?

Obviously, doing a chargemaster year-end update means everything must be completed by January 1. It’s the non-negotiable implementation date. All the changes need to be in the system before going live on the first of the new year. Remember the holidays though – they frequently interfere with year-end schedules.

Consider setting the end-date deadline to earlier in December. Setting a date before December 31 allows some wiggle room and an opportunity to test in advance, particularly mapping between systems.

Creating the Step-By-Step Framework

STEP 1

Determine the Overall Work Effort

Use policies and procedures to determine the overall work effort. All the details required should be set up at the get-go:

• Organize all the necessary guidance
• Retrieve templates or instructions on how to make changes in a system
• Acquire project plans from prior years, if available
• Include in your policies a suggested maintenance schedule — VitalCDM has a report
• Determine timelines and key resources
• Ensure the needed data is available
• Schedule a kickoff presentation for key stakeholders
• Set up a specific email address or inbox for any process questions

STEP 2

Organize the Data

This may seem obvious, but it's worth thinking about ahead of time: you’ll want to organize the data in a way that is most useful to the process of making all the changes. Create current CDM reports specific to your organization.

If using VitalCDM, use the prospective analysis for 1/1/xxxx. The dashboard will provide a view of the number of lines affected by future changes. Combined with analysis reports of change details, your team will be able to analyze the data, particularly the Status Indicator and/or Payment Change report. This will determine the scope of effort needed, as well as revenue impact.

Organize the Full CDM Data

The chargemaster should be current based on your ongoing maintenance, however, it’s still important to review the CDM for any remaining deleted or inactive CPT codes. And it is critical to remediate any lingering inaccuracies in the CDM prior to implementing year-end changes. In addition to running the CDM for both deleted and invalid codes, you should also get reports for “Deleted by Department” items. If you’re using VitalCDM, you can run an overall report, plus these individual code reports, for a clearer picture of which codes need to be replaced, which older codes might need to be kept for Medicaid reimbursement, etc.

STEP 3

Next Year Data Acquisition

For this step, we can tell you what this looks like if you use VitalCDM. Begin this part of the update process by retrieving the VitalCDM prospective analysis reports and the 20XX CPT code updates (available from the VitalCDM main dashboard). Look at the Codes That Are Deleted, Codes Being Added, and Codes Being Changed to get a feel for the workload.

As part of the revenue integrity team, you may be able to weed out some of the new charges. For instance, there could be a new PET scan CPT, but your facility does not do PET scans. You can immediately remove that data and don’t need to have that discussion with the clinical department.

STEP 4

Organize Department Data

Best practice is to take the overall data and organize it in a way that is useful to each department. Break it down into cost centers and show them what is relevant to their area. Determine what charges might be deleted, changed, or added based on the CPT/HCPCS code section. Job aids should specifically outline what analysis steps and action items you want them to perform with the data.

Tap Into Project Management Resources

Depending on how large your organization is, and if you perform a majority of available services, this project can get cumbersome. So, if there are any project management resources you can use, by all means, take the assistance. Key issues or project plan objectives include:

• Ensuring nothing is missed in the process
• Demonstrating how all interconnected departmental pieces will align
• Outlining milestones with due dates to get more buy-in and keep on track
• Allowing visibility into department progress
• Defining escalation points and “at risk” elements

STEP 5

The Kickoff

Review all of the planning and decide who’s going to be on the kickoff team, what information needs to be shared at the kickoff, and when it will occur. Kickoff is the time to provide educational material, job aids, timelines, data, contact emails, and to arrange departmental meetings. You may also wish to appoint someone as “CDM Associate,” to be the point person for each service line, department, or cost center.

STEP 6

Department Interviews

This is possibly the most important part of the process. It allows CDM staff the opportunity to do a complete, high-level review with the department and organize the codes for the upcoming year. Use a consistent interview process to go over deleted, added, and revised codes — as well as zero usage items and their CDM analytics.

STEP 7

Update Corresponding Systems

Once changes to the chargemaster are identified and placed into workflow or a worksheet, adjunct systems must also be updated. It’s a good idea to begin with physician ordering. Ensure changes are communicated to ordering providers, provide instruction to clinical areas, and inform the medical executive committee of the changes so they are able to work better with providers.

Then move on to updating clinical systems such as LIS. Ensure the updates are linked to the physician order type, and any internal mapping between systems is created. Follow this with updating testing descriptions and educating staff on the changes.

Pricing and Revenue Impact

Proper pricing of all the changes is essential and should be done in tandem with the Finance department per your hospital policy. Pay special attention to replacement codes and deletions, though it is important to review all pricing at the annual maintenance review.

It’s a good idea to run a peer pricing analysis, too. Where do you fall in your current marketplace? Most expensive, least expensive, or somewhere in the middle? With the new price transparency requirements, it’s important to have a sound, defensible pricing strategy as you build in these new charges.

Audit the Implementation

The audit cycle is the last crucial element to your success. Set the standard with CPT/HCPCS code changes. Then measure your current practice against the standard and compare results. Change the practice to best practice — and continue remediation until there are zero failures. Complete the cycle with a re-audit. You want to make sure everything you’ve created works as designed come January 1.

We like to say audit, audit, audit, then audit again to make sure everything is right. Ensure changes are made and mapping is correct so you don’t “blow up” a biller’s work queue, fail claims, or miss charges.

Summary

Clearly, year-end CDM maintenance requires rigorous activity. A robust work plan should be made in detail to ensure nothing is misplaced or missed. An internal landing site is a great way to provide all materials to stakeholders, and job aids are key to delivering understanding of clinical deliverables. Check the mapping and validate the linkages – your CDM might be compliant, but failed mapping can create charge errors and lost revenue. And finally, run reports frequently.

A good plan, with a structured approach and good technology, will make the process as seamless as possible and put you well on your way to a successful year-end update.

You may also like:

• Webinar: A Strategic Plan for Year-end Chargemaster Updates
• Webinar: Financial Best Practice Emergency Services Revenue Cycle
• Article: How to Design a Hospital Charge Capture Audit