Chargemaster Standards.docx - The UMUC facility has decided...

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Unformatted text preview: The UMUC facility has decided to undergo a review of its chargemaster to ensure that it meets the above criteria. In addition to the comprehensive evaluation, one of the other objectives of the project will be to institute the procedures to ensure that all additions, revisions, and deletions meet the chargemaster standards. How could the facility measure the success of the chargemaster review project? Which facility departments should be included on the project team? Describe the role and responsibilities of each team member? Who would be the most appropriate project sponsor? Who are the project stakeholders? The charge master is main pricing list of all service and supply charges within an organization. For hospitals that includes both in and outpatient transactions. Though simply stated managing the charge master is a very complex job. The charge master's role in the coding process differs from department to department, and not all codes provided on a claim form are necessarily included in the charge master, as codes for complex services may need to be developed and reviewed by coding staff (Abbey, 2001). Charge masters in most places are also used for tracking the usage of resources purchased. The success of the charge master lies heavily on the quality of organizational leadership and whether or not it is an administrative priority. Other ways to ensure its success is to create departmental accountability and ownership, set up consistent, controlled system generation pathways for files, incorporate reviews into every revenue cycle team meeting, improve pricing fundamentals, establish a regimented, controlled review process, schedule regular reviews, conduct proper training and educational resources, improve claim submission through improved customer service and lastly, review, audit and repeat these steps (Stroudmaster, n.d). A system that is successful has a central chargemaster team with sufficient time and resources. Measuring the success can also be done by analyzing improvements in the charge capture and collections, uniform price and volume analysis, and reduced risk of payer audits and penalties (Barton & Bieker, 2007). Facility Departments should include but not limited to: Compliance Officer: participates as needed to remove barriers, foster communication, and provide leadership and direction Technical staff from department: to share appropriate codes, product descriptions, costs for services/supplies used in their department Billing department: ensure appropriate revenue codes for each payer is listed on the charge description master (CDM) Finance department: assign organization charges to each line item on CDM. Coordinates the audit effort, schedules stakeholder meetings, and conducts the actual audit, reports audit findings, makes the corrections in the CDM, and handles post-audit communications and followups. IT Department: Make changes to CDM in computer system as necessary CDM Coordinator: make sure policies and procedures are compliant Contracts Department Rep: managed care contracts subject matter expert. He or she has access to all relevant managed care contracts, which detail certain contract-specific pricing and coding requirements (Richey, 2010). Project sponsors would be all healthcare entities with the compliance officer spearheading any audits. Stakeholders are anyone involved in care from the patients, insurance companies, managed care organizations and all medical facilities. References: Abbey, D.C. (2001). Designing and maintaining an effective chargemaster. Healthcare Financial Management, 55 (3): 50-5. Retrieved from Barton, S. & Bieker, M. (2007). Super standardization: one health system, one chargemaster. Health Financial Management, 61 (9): 74-6. Retrieved from Richey, J. (2010). Conducting a charge description master audit: getting the most value from an internal review" Journal of AHIMA 82: 28-31. Retrieved from Schaum, K.D. (2011). Who’s making the charge description master? Advance Skin Wound Care, 24(11): 500-2. doi: 10.1097/01.ASW.0000407656.22242.91. Stroudwater Revenue Cycle Solutions. (n.d). Top 10 chargemaster success fundamentals. Retrieved from Discussion 2: In a minimum of 250 words, explain how fee for service and capitation payment systems affect the physician’s role as the patient’s agent? Second, the move from cost-based payment for hospital services to payment on DRGs was expected to change hospital behavior. Discuss what you would have expected to observe as payment methods changed? ...
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  • Fall '18
  • Earl Greenia
  • Project Management, compliance officer, Richey, charge description master, charge master, Facility Departments

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