Review Your Charge Master to Ensure Complete APC Billing

Technically, Medicares new ambulatory payment classification (APC) system for outpatient reimbursement wont affect the charge master. None of the CPT or HCPCS codes will change. But facilities cant afford to ignore APCs and their relation to the charge master, warns Caral Edelberg, CPC, CCS-P, president of Medical Management Resources an emergency department coding consulting firm in Jacksonville, Fla. APCs are going to be the catalyst for requiring hospitals to do what many of them have needed to do all along, fix up the charge master.

Under the prospective payment system, facilities must pay more attention to the outpatient billing process, says Violet Thetford, FHFMA, budget director for Tuality Healthcare, a hospital system in Hillsboro, Ore. Outpatient billing has always been scattered. You dont really take pains to make sure that all the charges are on one bill. But now, if a patient comes in and gets several tests or has several procedures done, youll want to make sure you get them all recorded so you get the right APC grouper.

APCs make no provision for late charges, so every department must have its bills in at the same time, Edelberg explains. That requirement will put a lot of pressure on facilities because often the people who use the charge master cant find the proper references for codes and services. They could be there, but in unusual terminology. Or they havent been updated.

Facilities with charge masters that use revenue codes will be hit particularly hard, Thetford said. Now the CPT codes will have to be there, and the correct descriptors.
Under APCs, coding accuracy becomes even more important, she maintains. Its time to make sure that your CPT codes are accurate, that your descriptors are accurate, that your modifiers are accurate.

Conducting a Charge Master Review

Nobody wants to sit down with a code book and double-check everything that goes on a hospital bill. Yet facilities must make sure that everything gets recorded on the UB-92 charge form.

Thetford requires the managers of each department, like ancillary services, emergency room and nursing, to ensure the accuracy of charges from their areas. But they believe that its just taking too much time. The alternative is that you have one or more people monitoring it for the hospital at large, but that would mean that the designated person would have to be somewhat of an expert on everything.

The first step of the process is the hardest, and once a hospital takes the time to review its charge master, keeping the program up-to-date should be a manageable task. The charge master review process is simple, if tedious:

1. Print up the charge master, complete with CPT codes and HCPCS codes.

2. Look up the codes to determine that the [...]

- Published on 2000-06-01