Take these steps to keep your chargemaster updated
And how to keep it that way
Coding professionals will need to pay even closer attention to the chargemaster than they have in the past, and this is not an easy task.
However, with the right guidelines, it can be done competently and consistently. Lora A. DeWald, MEd, RHIA, CCS, CCS-P, vice president of health information management at Avera Health in Sioux Falls, SD, offers these 14 steps to keeping the chargemaster updated:
1. Organize a management team consisting of:
- accounting — persons responsible for the cost report;
- business office — biller;
- information systems — programmer;
- HIM — coder.
2. Depending on the size of your facility, you may have to establish charge description manager (CDM) teams at the department and even interdepartmental level. For example, the Radiology Department CDM team may consist of four management team members, plus the radiology department manager and support personnel for overall department oversight, as well as interdepartmental CDM teams for services such as interventional radiology.
3. Identify charge lines that are currently active by having Information Systems generate a report listing all the charge lines that were active during the past year.
4. Match these charge lines against the chargemaster.
5. Delete from your chargemaster all charge lines that are not currently active. Make certain you retain an intact copy of what you currently consider your chargemaster for cost reports, audits, and other look-backs.
6. Finance/Accounting should review charge lines on your revised chargemaster for appropriate cost center placement. For example, rental for a colonoscope should be in the procedure room/ OR cost center, rather than in the cost center for medical supplies.
7. Distribute departmental chargemasters to department CDM teams. If you are a very small facility, you may be able to work as a "committee of the whole."
8. Do a line-by-line review to match the revenue code, descriptor, and HCFA Common Procedure Coding System (HCPCS) code to each charge number.
9. Identify and code all supplies, drugs, and other pass-through items that require HCPCS codes and special revenue codes, such as chemotherapy drugs that require J9XXX series HCPCS codes and a 636 revenue code.
10. Decide:
- what HCPCS codes will be assigned through the chargemaster;
- who assigns which HCPCS codes;
- who assigns modifiers;
- who makes changes to the chargemaster;
- how charge lines are added and deleted;
- how pricing is determined.
11. Monitor, monitor, monitor!
12. Look for:
- duplicate HCPCS codes for same service;
- unbundling — two HCPCS codes billed when one is more appropriate;
- Correct Coding Initiative edits;
- correct charge lines on the itemized bill;
- accuracy of the UB-92;
- appropriate payments.
13. Design a procedure to maintain your chargemaster.
14. Identify an individual who:
- serves as a liaison between the billers, coders, and clinical areas;
- is responsible for reading and overseeing implementation of program memoranda, newsletters, and bulletins;
- annually distributes new CPT, HCPCS, and ICD-9 CM coding manuals;
- works with departments to implement updates as necessary;
- monitors, monitors, monitors!