A current and accurate billing procedure is vital to any healthcare provider seeking proper reimbursement. Without one, the facility would not receive appropriate payment for procedures and services performed on a patient. It’s thus very important to stay on top of the potential negative effects of a cdm charge master that has been neglected. Here are three helpful questions to consider.
Are Your Codes Accurate?
It’s important for the chargemaster coordinator to verify that correct codes are being billed. Inaccuracies may exist between what is captured in the order entry system and what is being reported on the chargemaster. Mistakes such as assigning a deleted or non-billable code to a medical procedure are more common than not in facilities with more than 150 beds. The coordinator should work with coding staff and providers to verify that line-item descriptions always match entered codes.
Are Your Codes Complete?
Without a complete and up-to-date set of codes, procedures and items can go unbilled. In a busy facility, personnel often have no choice but to skip the entry of a procedure or item for which a code is missing. This can result in untold revenue losses. So it’s critical that the coordinator periodically audit all departments.
Are Your Codes Compliant?
Facilities should review their chargemaster to maintain compliance with federal and state coding standards, as well as commercial payer rules. The danger of not doing so can result in overpayments to a patient due to a reimbursement. It’s advisable to review compliance on at least a quarterly basis by having the coordinator meet with all personnel who enter codes in the chargemaster.
A comprehensive maintenance strategy for your chargemaster is vital to the revenue stream of your healthcare facility. Consider hiring an outside clinical coding expert with a track record of restoring accuracy and functionality.