March 8, 2022

A New Year’s Resolution – Working on Our Core 

Jeremy Hung

A New Year’s Resolution – Working on Our Core 

Like many folks, an annual tradition as we turn the page into a new year is to come up with new year’s resolutions. And of those items, many revolve around improving our health and strengthening our core. So, as we move into the second month of 2022, and the mid-revenue cycle continues to be a trending topic, we would like to call attention to the core of the mid-revenue cycle: the hospital Charge Description Master, also known as the chargemaster or CDM.  

Maintaining and updating the chargemaster is a key component to a high-performing health system as the CDM is the source of truth for all billable (and sometimes non-billable) services provided by your facility. The chargemaster enables your organization to post charges that populate itemized bills and claims that directly lead to reimbursement.  

In the sections below, we will review general CDM maintenance best practices as well as highlight some ways you can supercharge your CDM build to take advantage of all the bells and whistles your EMR system has to offer.  

The Warmup – A Charge Description Master (CDM) Overview 

Let’s warm up with some CDM basics. The hospital chargemaster is a list of all the services, procedures, products, and supplies for a given facility or system. The CDM captures the description and price but also holds much more information about the product or service provided. The CDM also houses the revenue code, CPT/HCPCs, and modifier information that is pulled to produce claims. Each of these items plays a key role in capturing accurate and compliant charges, paving the way for smoother back revenue cycle management.  

A Plank a Day Keeps the Doctor Away – Daily CDM Maintenance 

Daily maintenance is required to keep up with the changing needs to keep your CDM accurate, complete, and compliant. This work includes such items as new charge requests from departments, CPT/HCPCs updates, price updates, and revenue routing corrections. Due to the high number of expected daily requests, it is important to ensure a standardized intake process to streamline the work and track the request all the way through to completion.  

Annual Check-Ups 

At a minimum, an annual review of your hospital chargemaster is recommended to maintain the overall integrity of the data. In addition, there will be other scenarios that prompt a review of your CDM. When a new EMR or financial system is being implemented, or when a new department or facility is brought up, this presents a wonderful opportunity to start with a fresh, clean, accurate, and streamlined CDM to jumpstart the new year for your organization.  

A thorough review of a hospital chargemaster can seem like a daunting task. To overcome data overload, breaking the review into parts will make this much more manageable. In addition, it will be important to have a set of standards regarding your CDM consolidation strategy to help guide you through this process. By categorizing the work into parts such as the ones below, the work can be completed in a more efficient manner.  

  • Inactive Codes – Use revenue and usage reports to inactivate unused codes. This can have a significant impact on the CDM cleanup effort.  
  • Duplicate Codes – Review duplicate CDM line items, based on CPT and HCPCS codes to review consolidation opportunities. You can make use of alternate procedure code logic in the system to satisfy differences in payor requirements for the same procedure across multiple departments. Interested in other ways to leverage system capabilities? Ask us how! 
  • Missing Chargeable Items – Clinical department review is essential to validate existing chargeable items and identify additional revenue opportunities for previously uncharged services.  
  • Incorrect/Outdated Codes – Quarterly or annual updates published by AMA and CMS need to be reflected in your CDM to ensure accuracy. 

It is recommended to integrate the changes in the CDM to the clinical modules of your EMR through a workstream we at Wilshire call CREW, the Clinical Revenue Enterprise Workgroup. This group works closely with the clinical departments and the IT teams to automate and integrate charge capture processes as well as facilitating communication to ensure a smoother process for integrating CDM and clinical build updates.  

Benefits of a Stronger Core 

A streamlined chargemaster will reduce the scope of ongoing maintenance, freeing up staff to support the ever-changing demands required by CMS, as well as changes within your own organization. Your slimmed down and toned CDM will require fewer resources and allow for quicker review of the required yearly updates that follow. With frequent and proactive review, you are taking the steps needed to ensure a more complete, accurate, and compliant chargemaster. 

If you are interested in hearing our thoughts about CREW, the chargemaster, charging optimization, clinical integration, or any of our other Revenue Integrity offerings, please reach out to us. We would love to share our lessons learned from previous implementations as well as our take on current industry trends. Check out our Revenue Integrity page to see some of the services we offer in this space.    

 

 

Jeremy Hung

Senior Strategic Advisor

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