Most hospitals don't know just what it is that charge master and charge capture processes are supposed to be. The large companies don't want hospitals to know because they want to be able to charge for substandard work. How do I know? Because I've worked in other capacities within a hospital and I've seen how some of these companies come into a facility and not give the facilities what they were hoping for. Then those hospitals, on the back end, aren't sure what to do with what they've been left with, and they can't find a way to get any real help on the back end.
As I said in my article on misperceptions of the process, prices and services can range fairly drastically, depending on what the client wants. However, what I've also noticed is that, sometimes, hospitals get exactly what they pay for, which isn't good when they decide to go for the lowest price all the time. No one wants a lot of information they can't use, but no one also wants to be left trying to figure out what to do with what they receive. Below is how we do it.
Everything starts with the charge master, and a breakdown of all departments. Once we receive an electronic copy of it, we can start working on the process of verifying all codes; this will entail CPT/HCPCS, revenue codes, and, modifiers if available (some computer systems don't allow this in the charge master). Depending on the hospital size, and its complexities, working on the charge master can take anywhere from 30 to 60 hours. The disparity depends on just how many line items are on the CDM (charge description master), especially pharmaceuticals and supplies.
At this point, the next phase depends on what else the hospital has asked for. If they've supplied revenue statistics then that becomes part of the integration of the charge master process, and it behooves all hospitals to supply this information. There are often many duplicate charges that can be eliminated by reviewing revenue statistics, and other charges that may be missing that are noticeable because certain charges are out of whack with normal productivity. One major goal of charge master reviews is to eliminate clutter, and it's hard to do without reviewing revenue statistics.
Also, a request for a minor pricing review based on Medicare reimbursements for one's particular area is a good thing to have done. It's quite common to find out that many groups of services that are provided are either lower than, or pretty close to even with, Medicare fee schedules, based on the APC (ambulatory payment classification) listings. Medicare will always pay based on the lower figure of fee schedule or hospital charges, and of course these rates will affect some other payments from other payers.
The next piece is the interviewing phase, which can be done by phone, but truthfully should be done in person with either department directors or those who are in charge of capturing the charges. This process should take about a week, less if it's a small hospital, more if it's a multi-hospital facility. For this stage, there may be more than one person who visits the hospital to conduct the interviews, which helps speed up the process. A good company isn't going to speed through this process just to save time; they're going to ask some tough questions because their goal is to give you the best service possible.
After all interviews have been conducted then it's back to the office to do any updates to the CDM, based on what the interviews may have brought out, and then it's time to write up the report. The report will be a combination of what was discovered during the interview process, what was discussed, the charge capture process, and all specific recommendations for changes we recommend. It will be broken down by department; some departments may not have much, others will have plenty. When regulations need to be provided based on what was discovered, they will be entered into the report. Where we differ is that we will not pad the report by adding extraneous information that a hospital isn't going to read anyway. Only what's needed to clarify recommendations or findings will be included in the report. This process will take from one to two weeks, depending on the findings, and what type of information is requested.
The final piece will be the review of the report, which can take place on the phone or in person. The hospital will receive both the full report and an electronic copy of the CDM, broken down by department so implementation is easy to perform. We also offer three months of support for any recommendations we've made that are specific to the CDM.
Any other services requested after the report will begin a new round of negotiations. This includes more extensive assistance with the charge capture process. The charge capture process could include more intensive work with each department in helping them refine the capture of their revenue, or could include the physical updating of the charges in the hospital's system, which could take place in person, by phone, or with remote access. Of course, we also offers services as they pertain to the receivables side of things, which could go hand in hand with the charge capture process in many instances.
T. T. Mitchell Consulting, Inc, goes above and beyond in its charge master and charge capture processes. Our goal is not necessarily to increase hospital revenues, although that is almost always guaranteed, but to make sure the hospital is capturing all the revenue it should be capturing, capturing it properly, and staying within the legal boundaries of correct charge capture and coding.
For more information, please contact:
T. T. Mitchell Consulting, Inc.
P. O. Box 2512
Liverpool, NY 13090