Advanced Charge Master Techniques

Advanced Charge Master Techniques - Planning Notes

Planning Notes For Advanced Charge Master Techniques

Title: Advanced Charge Master Techniques

Objective: To present and discuss Charge Master strategies and techniques that assist hospitals in meeting revenue enhancement along with proper compliance. This workshop goes beyond the basics addressing advanced topics that represent challenges to Charge Master Coordinators and associated coding, billing, reimbursement and compliance personnel. Emphasis is placed on understanding complex issues and on systematic ways in which strategies surrounding the Charge Master and associated claims development processes. This workshop is a sequel for the basic workshop, “Charge Masters: Reviewing & Assessing”, and the “Beyond the Charge Master” workshops.

Upon Completion the Participants Will:

1. Have reviewed the purpose, function and role of the Charge Master relative to coding, billing and reimbursement.

2. Appreciate the extreme need for compliance relative to statutory compliance with Medicare and Medicaid.

3. Understand the need to also optimize the coding, billing and reimbursement process through the Charge Master for non-Medicare third-party payers.

4. Appreciate the conflicts created by differing requirements from various third party payers.

5. Have the ability and strategy approaches to design the Charge Master to meet varying third-party payer requirements in order to generate appropriate reimbursement.

6. Appreciate the need to establish an overall Charge Master philosophy to meeting statutory compliance while also optimizing for proper payment.

7. Understand the OIG’s interpretation of the ‘Medicare Charging Rule’ and how this compliance issue affects the Charge Master design for other third-party payers.

8. Appreciate setting charges in special situations such as provider-based clinics and the Emergency Department.

9. Appreciate the complexities of coding, billing and organization of the Charge Master for Interventional Radiology, Catheterization Laboratory and Vascular Laboratory service areas.

10. Understand how different contracting and payment systems alter the design of the Charge Master and its interface to the billing system.

11. Appreciate the impacts that the HIPAA Transaction Standards and Standard Data Set will have on the design of and requirements within the Charge Masters.

12. Understand how to perform research on the Internet and other sources for information relative to researching and addressing specific questions/problem areas.

13. Appreciate potential future requirements under the APC Payment System and the impacts that will occur to the Charge Master design and implementation.

14. Have knowledge of additional resources relative to establishing and maintaining the Charge Master.

Audience: Charge Master Coordinators, Patient Financial Services Managers, Hospital Business Office personnel, Health Information personnel, Professional Coding Staff, Information System personnel, Finance Department personnel, CFOs, CIOs, Managed Care analysts, Cost Accounting personnel, Financial Analysts and other personnel involved with the Charge Master. (Note: This is an advanced workshop. While those new to the charge master and associated billing processes are welcome, a background in this area is assumed on the part of the participants.)

Method of Presentation: The primary method is LectureRecitation with the use of detailed case studies. Interaction and questions from the audience are HIGHLY encouraged.

Course Materials: Extensive Class Notes (including copies of Overhead Transparencies). Class Notes will include copies of selected readings and special materials as appropriate.

Student Materials: None required. Participants are encouraged to bring their hospital’s Charge Master and/or selected section. CPT Manuals and UB-92 Editors are optional.

Prerequisites: Participants should have knowledge of Charge Masters, the billing process and general coding concepts. This is an advanced workshop; thus, it is assumed that participants have some background and experience in this area.

Course Times: 9:00 a.m. to 12:00 p.m., 1:00 p.m. to 4:00 p.m.

Outline:

I. Introduction

a. Charge Master Function

b. Charge Master Form and Development

c. Purpose and Use of the Charge Masters

d. Charge Master Compliance Issues

II. Philosophical Design

a. Charge Master Building Blocks

b. Primary Philosophical Design Strategy

c. Secondary Philosophical Design Strategies

d. Billing System Capabilities

e. Overall Coding, Billing & Reimbursement Flow

f. Overall Compliance Considerations

III. Payment System – Third Party Payer Optimization

a. Service-Charging-Claims Development Cycle

b. Medicare Optimization

c. Non-Medicare Optimization

d. Typical Contractual Scenarios

i. Percent of Charges Approach

ii. Based On Another Payment System

iii. Discounted Approaches

iv. Hybrid Approaches

e. Standard Code Set Utilization

f. Inclusion/Exclusion of Chargeable Items

g. Hospital Infrastructure Development To Address Contracts

h. Secondary Payer Differences

i. Claim Modification Considerations

j. Cost Report Utilization and Interface

k. Compliance Concerns

i. Statutory Compliance

ii. Contractual Compliance

IV. Medicare Charging Rule for Non-Medicare Payers

a. Charge Development

b. Cost Accounting

c. Understanding The Medicare Charging Rule

d. Preferential Fee Schedules

e. Charge Levels Within Third-Party Payer Requirements

f. Discounting Considerations

g. Provider-Based Clinic Fee Schedules and Billing

h. Emergency Department Fee Schedules and Billing

i. Special Situations

V. Special Service Area Considerations

a. Oncology

b. Catheterization Laboratory

c. Vascular Laboratory

d. Interventional Radiology

e. Provider-Based Clinic/Services Situations

VI. Special Situations and Preparing For The Future

a. HIPAA

i. Transaction Standards

ii. Standard Code Sets

b. Charge Master Utilization For Activity Accounting

c. Future Payment System Design Requirements

i. APCs – Multiple Service Claims

ii. Conflicting Payment System Requirements

iii. Future Code Set Development/Implementation

VII. The Future and Sources for Further Information

Notes:

1. This is an intensive oneday workshop emphasizing practical applications of the information provided.

2. This workshop is a follow-up workshop to both the basic 1-day “Charge Masters: Reviewing and Assessing” and the 1-day “Beyond the Charge Master” workshop.

3. Questions submitted prior to the class are encouraged!

4. Reference materials will be made available to class participants as a part of their notes.