REIMBURSEMENT UPDATE: Quick Guide to Chargemaster Success

Experts reveal 3 tips that keep YOU in charge
Preventing CDM errors -- and loads of lost reimbursement -- can depend on your day-to-day knowledge of regulatory updates, pharmacy guidelines, and where your entries end up.
Read the News
Facility staff who deal with the charge description master (CDM) need to keep up with current developments unfolding in Medicare and with third-party payers, says Ralph Llewellyn, CHFP, CPA, partner in health care services at Eide Bailly LLP in Fargo, N.D., who presented on chargemaster issues at the American Academy of Professional Coders Annual Conference in Atlanta. Read newsletters from Medicare and third-party payers, and pay attention to Medicare one-time notices, he says.
Don't overlook: Don't leave the reading up to just one staff member -- make sure your staff distributes these updates to the rest of your facility. "You don't want to get burned -- have somebody read everything," Llewellyn says. "Have a tracking mechanism to make sure it happens."
Treat Pharmacy Separately
If possible, keep a pharmacist on your chargemaster committee, Llewellyn says. "With all the changes of the Medicare Modernization Act last year, I don't know how you'd [update] without one," he says. "You've got to have somebody who's really up on all the drugs, because [the government] opened up the doors again as to what you can report and get paid for" in the hospital pharmacy. "I find tons of reimbursement opportunities that are being lost due to HCPCS coding," he says.
And the problem isn't just selecting incorrect HCPCS codes -- staff members unfamiliar with the proper way to break down medications into units won't know how to change them in the CDM. "Make sure whoever's trained to use the CDM codes understands what they do. We focus a lot of the time on 'cap-ture'in the hospital," says Cindy Parman, CPC, CPC-H, RCC, co-founder of Coding Strategies Inc. in Atlanta, who presented at the AAPC conference.
"We just found a $3,000 mistake on one claim -- those dollars add up fast," Llewellyn says. Pharmacists, on the other hand, know unit breakdowns, HCPCS codes, which drugs are covered, and usually, how much reimbursement you'll earn for them.
You should also make sure you have a list in the pharmacy that shows which drugs are self-administered and which aren't, because that distinction tells you what you can and can't charge.
The CDM-Cost Report Bond: Never Too Close
Secret: Everything you do on the chargemaster flows to the cost report, Llewellyn says. Most facilities are unaware of this, but you should design your CDM functions with this in mind.
Here's the connection: [...]

- Published on 2004-07-09