View
2
Download
0
Category
Preview:
Citation preview
CHARGE MASTER
ISSUES & PRIORITIES
AAHAM WESTERN REGION
CHAPTER
Presenter: Rosemary Holliday May 2013
Hot Topics
2013 CDM Update Highlights
Charge Management Processes
Today’s Charge Master Challenges
Agenda 2
Hospital Pricing in the Spotlight
Recent News:
“Bitter Pill” and “Killer Apps”
Medicare Provider Charge Data
Pricing in the Press
3
Strategies
1. Take the offensive
2. Ensure defensible
charge data
3. Pricing image ‘self-
check’
4. Identify basis for
pricing
5. Realistic Perspective
6. Develop a plan
4
Hospital Pricing in the Spotlight 5
Pubic Relations
Processes
Data
Revisiting 1Q2013 Updates 6
What happened?
Why was it challenging?
What was the outcome?
Revisiting 1Q2013 Updates
What Happened?
CPT & HCPCS code changes
CMS payment system updates
Implementation by payers & providers
Operational and reimbursement impact
7
Revisiting 1Q2013 Updates
Why was it Challenging?
Quantity and type of updates
Timelines
New charge structures & repricing
New documentation and charge capture
Limited payer guidance
8
Revisiting 1Q2013 Updates
What was the outcome?
Weak CDM processes exposed
Collaborative relationships strained
Department engagement taxed
‘Stars’ &‘black holes’
9
2013 CDM Updates 10
Top 10 Areas of Impact
Psychiatry
Psychiatric diagnostic evaluation
Psychotherapy
Crisis psychotherapy
Add on codes
11
Rehab Services
Caps
Threshold
MPPR
Functional Reporting
CMS Claims Edits
12
Cardiovascular System
Vascular Injection Procedures
Therapeutic Services
EP
Charge & Code Capture
Coding Resources
13
Diagnostic Imaging
Bundling Continues
Diagnostic Imaging
Nuclear Medicine
Radiology Modules
14
Pathology & Laboratory
Code updates
Miscellaneous Code updates
Molecular Pathology
Regulatory Updates
CA Laws
H.I.S. Integration
15
Neurology
Coding Updates Neurostim electrode array implantation
Chemodenervation
Nerve Conduction Tests
Intraoperative Neurophysiology
Autonomic Function Tests
Motion Analysis
Motor Function Mapping
Vagus Nerve Blocking Therapy
16
Pharmacy
Code Updates
CMS & Other Payer Req’mts
H.I.S. Functionality
Pricing
17
RT / Pulmonary Medicine
New Guidelines & Instructions
Code revisions
Sleep Medicine - peds
OPPS Updates
Long-standing issues
18
Ophthalmology
New & Established Definition
Other Code Updates
MPPR
19
E&M Codes
Visit Codes – Trends & Politics
C4 & TCM Services
Pediatric Critical Care Patient Transport
Supervision
OPPS Guidance & Payments
20
Other updates
Other CPT Changes
HCPCS Level II Codes
OPPS Pass Through Devices
Non-Medicare Codes
21
Remaining 2013 Priorities
Day-to-day charge management
Quarterly updates
Audits
Hospital projects & initiatives
2014 planning
22
Charge Management 23
Defining “Charge Management”
“Oversight and control of all
aspects of charge data
throughout the organization”
24
Assessing Charge Management
25
What’s our approach?
Reactive?
Proactive?
Somewhere in-between?
Rea
ctiv
e
Pro
act
ive
Assessing Charge Management
Quantify charge data quality
Quick Assessments
Indicators of accuracy
Third party feedback
Are assumptions correct?
26
Evaluation Techniques
Purpose: Identify SWOT
Example Evaluations
CDM Maintenance
CDM Annual Updates
CDM Data Integrity
CDM Management Performance
Issue Tracking/Resolution
Resource Inventories
27
Where do we go from here? 28
Challenges
Solutions
Resources
The Challenges
Time & Money
Skills & Processes
Impact of Change
Audit & Claims Defense
Projects, Priorities, and Politics
29
The Solutions
Unique for every environment
Personnel-driven
Costs to consider
Priorities
Level of Commitment
30
The Resources
Collaborative Efforts & Exec. Support
Process Improvement Strategies
Education
Data Analysis
Software Tools
Consulting Support
31
Summary
Hot Topics
2013 CDM Updates
Charge Management Processes
Dealing with the Challenges
32
33
Contact information:
Rosemary Holliday
(530) 550-0865 or (800) 831-3323
E-mail: rholliday@cdmpi.org
Web Site: www.chargeassist.com
Recommended