Maintenance Key to Preventing Revenue Leakage
When it comes to the hospital chargemaster (CDM), comprehensive maintenance is key to preventing revenue leakage. The chargemaster helps to ensure that charges are clean, accurate and properly composed. Along with regular auditing and focused revenue integrity efforts, a clean chargemaster is at the very center of a healthy financial operation. One of the key components to a comprehensive CDM maintenance program is an annual clinical department charge item review. At least once a year, the person responsible for managing the chargemaster should meet with clinical departments and ensure that their portion of the CDM is accurate and aligns with their charge tickets or screens. Because clinicians are on the front lines of patient care and know which services are in high demand, the chargemaster team should maintain open communication with clinicians to ensure the chargemaster contains all billable services and prices are accurate.
Reviewing Line Items for Existing Charges
While asking clinical areas to verify charge line usage, be sure to ask particularly about the charges that exist in the CDM but have not been used. In some cases, reviewing zero volume line-items can help uncover a charge capture problem where the service is actually being performed, but the charge is not making it to the claim. Most of the time, however, the charge line is not being used simply because it is no longer needed. In the latter case, these items need to be inactivated. Removing clutter from your CDM will simplify ongoing maintenance and reduce the risk of incorrect charges. Also, remember to remove the corresponding unneeded charge lines from the order entry system or charge entry sheet when you deactivate them in your CDM. Ask the clinical department leaders if the volume of data matches their activity. If not, take a deeper dive into the data. Is there a problem with the report that was produced by IT? Or is there a true glitch in the charge capture from the departments to the financial statements?
You should also ensure departments have and understand the complete code sets and line-items for their respective departments by:
- Understanding the services provided by their department
- Asking department staff if they provide services without charging for them or if they lack an appropriate code to use for reporting these services
- Reviewing new codes with staff to determine if additions to the chargemaster are necessary
- Verifying applicable codes that are not already on the department’s chargemaster
- Verifying that chargemaster and order entry line-items accurately describe the services being rendered
In addition, carefully examine the reported departmental revenue and usage volumes in conjunction with the charge line items in the CDM and verify their accuracy. A few of the standard charge line comparisons include:
- Comparing vaccines to vaccines administration
- Comparing radiology studies with contrast-to-contrast volumes
- Comparing ER visit levels to total annual ER visits
- Comparing blood product to blood administration
A clinical CDM review is not only a departmental technical review of the CDM file, but more importantly, it is an open discussion with each department representative to learn how clinical operations interact and link with the CDM. At a minimum, a review should occur every three years, if not annually. The end result should be a clean, up-to-date CDM for each department. Windham Brannon’s Healthcare Advisory professionals are well-versed in helping health systems with their CDM review and are here to help you improve its effectiveness and efficiency. To learn more, reach out to your advisor today, or contact Greg Brazzel.