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Improving Community Hospital Performance is Our Specialty

Chargemaster Compliance and Charge Capture Processes

Coding compliance is of utmost importance to revenue integrity, especially during this time of increased governmental scrutiny and auditing. Charge description master (CDM), or chargemaster, codes should be reviewed regularly to identify and correct any potential issues and ensure codes are current and being utilized appropriately. CDM reviews involve a line by line review of all services provided to ensure that CPT/HCPCS codes, modifiers, revenue codes and descriptions accurately reflect services performed. Compliant bills can then be submitted for proper reimbursement.

Because charges are generated in many areas across a hospital and the process always includes some type of human intervention, it is imperative that these processes be evaluated for effectiveness and financial improvement. CHC Consulting helps with a variety of charge capture services including assessment of departmental charge capture tools and processes. We also follow charges as they move from the original point of entry, through any relevant interfacing systems, to posting on the patient’s bill. In addition, daily charge reconciliation processes are reviewed and/or established to ensure success and accountability.

OUR FINANCIAL IMPROVEMENT SERVICES INCLUDE:

Benefits

  • CDM review services identify invalid or deleted codes and other discrepancies.
  • A line-by-line review of the CDM with each respective department ensures that each code is being utilized in a compliant manner and identifies all items and services that can and should be charged.
  • The changes identified during these sessions can be uploaded to the CDM file, resulting in a current, compliant and comprehensive CDM.
  • Timely and accurate charge capture is vital because this process drives revenue generation.
  • Charge capture provides the most appropriate measurement of resource utilization.
  • A thorough evaluation helps identify areas where charges may be lost either because they were not captured, or as they were processed manually or electronically.

Blog

Revenue Integrity — Taking Charge of Your Chargemaster

By Beth Kim

“Revenue integrity” has attained buzzword status, but not long ago, the term didn’t exist. The concept, however, is longstanding. It means being properly reimbursed for patient care while remaining compliant with all applicable laws and regulations. 

These efforts involve ongoing evaluations to make sure a healthcare organization’s internal processes and controls are supporting correct, compliant billing procedures to hasten payment and avoid denials. They’re meant to protect and strengthen hospitals by eliminating revenue leakage and compliance risks.

The buzzword took hold in recent years, as hospitals have been barraged by...

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