Description

The chargemaster is a lynchpin within the overall revenue cycle.  Keeping the chargemaster up-to-date both for reimbursement as well as maintaining proper compliance is necessary.  The chargemaster is a direct and indirect target of compliance for both governmental programs and private third-party payers.  Chargemasters are complex and can be organized in different ways.  Added to this overall mix is the continuing controversy over hospital pricing.  A carefully crafted systematic process is necessary to audit a chargemaster to make certain that various concerns are met.  The chargemaster must also be organized in a way that hospitals remain financially viable.

• How do you keep up with all of the CPT/HCPCS coding changes and their impacts on the chargemaster?
• How do you balance revenue optimization with maintaining compliance?
• What kinds of policy decision must be made with the chargemaster?
• Why is hospital pricing such a sensitive area?
• Should there be written chargemaster policies and procedures?
• Why are charges such a big deal?
• Why are the revenue codes sometimes ambiguous?
• How should supplies be handled?
• What about drugs and injections?
• What about nursing services?
• Should we be concerned about the cost report?
• Are there different kinds of chargemaster audits?
• How should clinical personnel be involved in a chargemaster audit?

Objectives of the session:

• To Review The Chargemaster As A Financial Tool
• To Determine if All Revenue Codes and CPT/HCPCS Codes Are Up-to-Date and Being Properly Reported
• To Understand Statutory Compliance Surrounding the Chargemaster
• To Appreciate the Contractual Obligations That Hospitals Have Concerning the Setup and Use of the Chargemaster
• To Have A Systematic Process to Review and Evaluate the Chargemaster
• To Discuss The Many Compliance Concerns Surrounding the Chargemaster Including Development of Pricing and Charges
• To Appreciate the Very Different Requirements Made By Different Third-Party Payers for Coding, Billing and the Chargemaster
• To understand how the Chargemaster affects and is affected by different payment systems including DRGs, APCs, MPFS and special hybrids.
• To Review Action Steps that Chargemaster Coordinators Can Take To Review and Update the Chargemaster and Make Improvements
• To Review Coding Changes for CPT, HCPCS, Modifiers and Revenue Codes

Agenda of the session:

1. Overview of the Chargemaster Form, Structure and Contents
   1. Billing System Influence
   2. Special Service Area Requirements
   3. Chargemaster Interfaces
   4. Pricing, Charge and Cost Report Issues
      1. Cost-to-Charge Ratios
      2. Tiered Pricing Formulas
      3. CDM Interface to the Cost Report
      4. Transparent Pricing
   5. Payment Systems
      1. DRGs and IPPS
      2. APCs and OPPS
      3. RBRVS and MPFS
      4. Special Hybrids – ASCs, Provider-Based Clinics
      5. Other
   6. 2018 Coding Systems – Revenue Codes, CPT & HCPCS
      1. CPT Changes – Coding Interface
      2. HCPCS Changes – Coding Interface
      3. Revenue Code Concerns
      4. Modifier Changes
2. Chargemaster Compliance Concerns
   1. Statutory
      1. Medicare
      2. Medicaid
      3. HIPAA TSC
   2. Contractual
      1. Private Payers
      2. Types of Contracts and Payment
3. Chargemaster Updating Review Process for 2018
   1. Personnel – Team
   2. Update Audit Objectives
   3. Type of Audit
   4. Conduct of Audit
   5. Results from Audit
4. Chargemaster Policies & Procedures – Judgment Metrics
5. Special Situations – Example and Case Studies
6. Chargemaster Coordinator Action Steps

Who should attend?

• Chargemaster Coordinators
• Billing and Claims Generation Personnel
• Compliance Personnel
• Patient Financial Management Personnel
• Cost Accounting Personnel
• Cost Report Personnel
• Financial Analysts
• Managed Care Contract Personnel
• Revenue Enhancement Personnel
• Chief Financial Officers
• Chief Compliance Officers
• Financial Planners
• Internal Audit Staff
• Utilization Review Staff
• Revenue Cycle Specialists
• All Other Hospital Personnel Interested in the Chargemaster.