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