Charge Master Tuning
More than ever before, it is critical that hospitals have an accurate, compliant and fully populated charge master. With profit margins squeezed so tightly, any loss of revenue must be eliminated. While this has always been important, the regulatory environment in which we now operate – combined with increasing pressure from various constituencies – makes charge master management much more than a “good thing”; it has become critical to your organization’s survival and prosperity.
Yet HFMA reports that, " On average, providers lose 5 percent of gross revenues, and that can translate into millions of dollars for a single organization. "
In the same report HFMA cited one Connecticut health system that found they were losing 31% of their net revenue.
An error in a single charge code will cause under-billing or over-billing each time that code is selected. Thus, one small error can result in a loss of thousands of dollars in revenue, or worse, it can be classified as fraud under the False Claims Act.
There are continual changes to the Medicare regulations, including CPT/HCPCS code changes that can have a significant impact on your reimbursement.
As reported recently by the HFMA, 56 percent of major problems associated with compliance and cash flow are a direct result of coding errors. More astonishing, 86 percent of those errors are a result of HCPCS coding with the biggest culprit being the charge description master; it is the source of 79 percent of HCPCS errors!.
With a few simple changes you can increase your revenue substantially.
Benefits
By fine-tuning your charge master you will:
- Stop leaving money on the table
- Improve cash flow .
- Decrease A/R days .
- Reduce write-offs.
- Maximize reimbursement for services.
- Eliminate non-compliance with government-funded programs.
- Reduce billing errors.
- Reduce payer rejections.
- Identify unrealized revenue potential.
- Improve your market share.
- Project your revenue for the coming year more accurately.
Target Issues
The most common charge master errors include:
- Outdated codes.
- Invalid codes.
- Improper use of miscellaneous codes.
- Inconsistent naming/numbering schemes.
- Priced below APC payment.
- Missing CPT/HCPCS codes.
- Mapped to wrong REV code.
- Incorrect Medicare descriptions.
- Procedures that should be billed under multiple codes.
