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Chargemaster: A Critical Tool For Revenue Cycle Management
Recorded Webinar
A hospital chargemaster is a comprehensive list of a hospital’s products, procedures, and services. Everything from prescription drugs to supplies for diagnostic tests has a unique price listing in the chargemaster and is used by hospital administrators, clinical documentation improvement specialists, and revenue directors.
Chargemaster rates serve as baselines when negotiating rates with payors but do not necessarily indicate the true costs of providing services. They should be updated at least annually, when new services are established, when current services are being discontinued and when percentage rates are increased.
Venue: Recorded Webinar
A hospital chargemaster is a comprehensive list of a hospital's products, procedures, and services. Everything from prescription drugs to supplies for diagnostic tests has a unique price listing in the chargemaster. Major components include revenue codes that reflect the site of service and applicable CPT/HCPCS codes that indicate the service provided/charged. Poor matches between these code sets may lead to distorted cost centers, lost revenue, charges bundled that should be separately reported and incomplete departmental charging. Webinar’s Goals Understand chargemaster code functions Understand revenue leakage resulting from poor chargemaster structure Understand why correct departmental charging is vital to revenue integrity Appropriate training for charge entry staff Billing attention to posted charges Who Should Attend Chargemaster Maintenance Staff Compliance staff Billers Coders Revenue Cycle Managers & Staff Risk Management Charge entry staff
Is your practice audit safe? Do you have compliance risks? The first issue will be where do you start to determine your risk. Some key questions to ask: Is this a compliance or educational audit? Is this a baseline audit or a more focused audit? Do you have an internal audit team or do you need to hire external auditors? The type of audit will determine where to start, how many services to review and the type of service(s) to be audited. Is there a time limitation? Has there been a previous audit that showed issues that need attention? Have there been internal or external complaints that need to be reviewed? This webinar will discuss best practices and all of these issues as well as how to determine a pull and how many services should be included in the audit. Webinar Objectives How to determine the scope/sample of the audit Government suggestions for auditing. The difference between a concurrent versus retrospective audit. What is the difference in an educational audit and a compliance audit What is an attorney client privilege audit. How does the type of practice change the audit focus. What are the risk areas depending on the type of physician practice. Webinar Highlights Auditing for office services Incomplete documentation for office ancillary services such as injections, cerumen impaction removal, nebulizer treatments etc “Incident to” Initial, subsequent hospital and observation services. Shared care Auditing for surgical and specialty practices Modifier usage Who Should Attend Office managers Compliance team and officers Coders Providers Denial management staff
Clinical documentation is the cornerstone for all patient medical records. This information should be of the highest quality to allow for optimal patient outcomes as well as supporting research, medical coding and other uses of the medical record. Its purpose is to adequately relate the patient’s current and historical conditions and treatments with primary focus placed on situations that affect the current medical encounter. It also supports the provider’s defense should the case become a legal issue. Webinar’s Goals Review of 7 criteria that all entries in the medical record should include Impact of documentation on coding & claims Establishing a CDI team Significance of abnormal lab results: querying the provider. Measurement of lesions, when taken and inclusion of margins. Why it matters & how reimbursement may be affected. Start & stop times & methodology for infusions & discrepancies in billing. Complete reporting for administration and substance. Diagnostic testing and medications should be supported in a diagnosis. Unsupported documentation may cost you money. Depth of wounds and cause should be clear. Clarity needed for both depth and origin of wound. Severity of illness. Hospitals and payers are increasingly scrutinizing patient severity. Lack of detail costs money. Diagnosis present on admission? Certain conditions do not generate additional revenue if occurrence after admission. Areas Covered The ICD-10 code set requires explicit documentation of conditions & treatments in order to support the severity of patients under treatment as well as allow for the significant specificity required by this code set. Ambiguous documentation and generic coding will no longer guarantee reimbursement and may generate a claims denial for lack of medical necessity. In this session, we will review the theory of high-quality clinical documentation which has the support of healthcare regulatory guidelines and peer-review research. Additional consideration involves medical outcomes that may result in legal action. When clinical documentation is vague, missing key elements and conflicting statements, the provider may find that he/she is handicapped in supporting medical decisions and patient results, particularly when the result is a negative outcome for the patient. In today’s healthcare environment, many patients have become educated consumers of medical services. They are more inclined to request their own medical record, carefully review explanation of benefits from payers, and request a review of any information they deem to be incomplete or questionable. Target Audience Coding Billing Revenue Cycle Physicians Mid-level providers Nurses Claims follow-up Compliance Auditors
The session will provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as review the Statute’s available safe harbors. It will also show how violation of the AKS can raise FCA concerns, and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants. We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are. We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law. Since one of the exceptions to enforcement under the Act is regulations promulgated by the Secretary, the “safe harbors,” payment practices that will not be subject to criminal prosecution and that will not provide a basis for civil monetary penalties or exclusion from the Medicare or Medicaid programs, we will examine these safe harbors, particularly those more frequently used, to show how protection from enforcement can be achieved. Specifically, we will review the investment, space and equipment rental, personal services/management contracts, and physician recruitment safe harbors. In addition, we will discuss the OIG’s Joint Venture Advisory Opinion, where a hospital expands into a related service line by contracting with an existing provider of that service. The OIG has significant problems with such an arrangement. We will also discuss the recent advisory opinion by the OIG regarding Physician-Owned Entities. OIG views PODs as inherently suspect under the AKS because the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the AKS. Finally, the webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it. Who Can Benefit Hospital executives, particularly CEOs, COOs, CFOs, CNOs, and CMOs; Nursing home executives; Physicians; Physician practice managers; and Other healthcare provider executives. Target Audience Hospital executives, particularly CEOs, COOs, CFOs, CNOs, and CMOs; Nursing home executives; Physicians; Physician practice managers; and Other healthcare provider executives. Background The AKS is currently the focus of law enforcement officials. The Statute provides that the offer or payment, as well as the solicitation or receipt, of “any remuneration” in exchange for referrals of any good, facility, service, or item for which payment may be made in whole or in part under Medicare/Medicaid is prohibited. Recent cases and/or enforcement actions involving the AKS, violation of which has been held to be the basis of an action under the Federal False Claims Act, (“FCA”) raise serious concerns regarding compliance issues with hospital, physician practices and other healthcare entities. Recoveries under the FCA are at an all-time high, and the percentage of actions involving healthcare organizations has been increasing at exponential rates. Areas Covered in this Presentation Federal Civil Anti-Kickback Statute, Safe Harbors providing protection under the AKS, Enforcement activities involving the AKS, The OIG’s Joint Venture Advisory Opinion, The OIG’s advisory opinion regarding Physician-Owned Entities, and The anti-fraud provisions of the Affordable Care Act.