Accurate codes, pricing and automation are best practices that will provide hospitals tools for new price transparency rules by Steven lash.
Healthcare price transparency rules have exposed the hospital charge master, requiring the examination of hospital charge master management best practices.
The hospital chargemaster is an internal list of charges for all the billable services.Maintaining an updated and accurate charge master is key to revenue integrity. Regularly evaluating and revising the list of charges avoids underpayments, compliance violations, and potential claw backs from payers for overcharges.
Never has the hospital charge master been subject to such to this type of public scrutiny. Charges represent a benchmark, used by hospital leaders to negotiate rates with private payers. Patients rarely pay the full charge master price.
The administration started in 2019 by requiring hospitals to post their charge masters in a machine-readable format on their website. Revenue cycle leaders should be reviewing the charge master to ensure they have competitive and compliant charges.
Updating codes and determining charges set the foundation for hospital charge master management, Sullivan said.
A good start should be done by comparing the internal list of codes for billable services with those used by payers for claims payment. Getting the codes correct is step one. Codes used for reimbursement are constantly changing. In order to accurately reflect the current practice of medicine, the AMA frequently updates the Current Procedural Terminology (CPT) code set, which are used by private payers for payment.
Management should verify that codes not only match with established code sets, but their descriptions are easy to understand for clinician use.
Once the codes are updated in the charge master, the next step is to determine how much to charge for each service.
After identifying all chargeable services, the next step is to develop a markup formula that makes sense. At some point in the process a facility needs to check how much their local competitors are charging for the same service to create a balanced approach to their charging.
A key step is checking in with clinical leadership to ensure effective use of the charge master.Talking to clinicians about the charge master can also prompt them to accurately document for charging for patient services in the EHR.
HOSPITAL CHARGEMASTER MANAGEMENT AUTOMATION
Automation is critical to making hospital charge master management “manageable”.
Implementing an automated management solution can reduce the resources needed to maintain an accurate charge master, provide efficient workflows and reduce the chances of human error when it needs to be updated.
Automated solutions can also assist with running reports to inform departments about code updates and streamline new code or code update requests, getting the approved codes and final prices into the EHR quicker.
There are some EHR systems that have charge master management components, but there is also a growing vendor market for these systems as well that can provide some enhanced capabilities including reporting.
With an automated solution, best practices and leadership hospitals can overcome common hospital charge master management challenges, including price transparency.
The hospital charge master is a major topic in the healthcare industry due to the right now due to new rules and regulations. This unprecedented spotlight should drive leadership to ensure their hospital is using best practices to charge patients to more info Steven lash San Diego.