NAVIGATING CHARGE MASTER STANDARDIZATION · 6/9/2015 · FINDING NEVERLAND: NAVIGATING CHARGE...

WeiserMazars LLP is an independent member firm of Mazars Group.

New Jersey HFMA June 9, 2015

F I N D I N G N E V E R L A N D :

N A V I G A T I N G C H A R G E M A S T E R

S T A N D A R D I Z A T I O N


A B O U T T H E S P E A K E R S

Stacey Harper is a Senior Manager in the Health Care Advisory Services Practice of WeiserMazars LLP. Stacey’s background includes assessment and implementation of process improvement initiatives across the revenue cycle including charge capture, patient financial services, denials, strategic and transparent pricing, and compliance. She is a Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), and Certified Professional Medical Auditor (CPMA).

Stacey Harper, RHIA, CPC, CPMA Senior Manager

WeiserMazars LLP 33 West Monroe Street, Suite 1530 Chicago, IL 60603

412.613.0309 [email protected]


A B O U T T H E S P E A K E R S

Taylor Pedone is a Senior Consultant in the Health Care Advisory Services Practice of WeiserMazars LLP. Taylor’s background includes assessment and implementation of process improvement initiatives across the revenue cycle including charge capture, patient financial services, denials, strategic and transparent pricing, and compliance. She is a Certified Professional Coder (CPC).

Taylor Pedone, CPC, Senior Consultant

WeiserMazars LLP 33 West Monroe Street, Suite 1530 Chicago, IL 60603

440.666.0930 [email protected]


L E A R N I N G O B J E C T I V E S

1. Charge Master Standardization Overview

2. Key Considerations for Charge Standardization

3. Pricing Strategies for Multi-Hospital Systems

4. Implementation Strategy

5. Case Study – Six Hospital System

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W H A T I S A C H A R G E M A S T E R S T A N D A R D I Z A T I O N ?

Detailed line by line review of each facility’s charge master for accuracy and compliance

– Revenue Codes, CPT/HCPCS codes, Billing Descriptions, Usage

Aligning facility charge masters with best practices to result in one cohesive charge master

Aligning departmental and system-wide charge master and charge capture policies and procedures

Consistent pricing strategy (not necessarily prices)

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B E N E F I T S O F C H A R G E M A S T E R S T A N D A R D I Z A T I O N

Consistent CPT/HCPCS, Revenue Code Assignment and Billing Descriptions – Ensure accurate coding and appropriate billing

Improved charge capture – Clinical manager involvement in standardization process

Uniform price and volume analysis – Improves revenue comparison and charge capture trending

Improved collections and reduced third-party denials – Compliant procedural coding, clean claims

Reduced risk of payer audits/penalties – Compliance, policies & protocols

Guidance Provided by protocols – Formal protocols, improved consistency

Easy updates on a global level – Streamlined process, central repository

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Affected departments: Compliance, Finance, Managed Care Contracting, Billing, Clinical Departments, Care Management, Patient Access, Revenue Integrity,

HIM/Coding, IT Initial Standardization & Go-

Forward Maintenance

Revenue & Usage review Charge capture method/process CPT/HCPCS code and Revenue

Code accuracy Billing description accuracy

Review for gaps and redundancies

Annual review for CPT/HCPCS deletions & additions

Policy for new charge generation

S T A N D A R D I Z A T I O N P R O C E S S

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Develop a chargemaster workgroup & project

leader

Line by line CDM review with clinical

departments

Implementation and Maintenance


C R U C I A L W O R K S T E P S

• Develop a chargemaster team • 2-6 individuals focused on maintaining the chargemaster and protocols,

verifying ongoing compliance, and a departmental resource

• Assign a project leader • Representation from each hospital

• Assign a project champion / sponsor • Ensure system-wide support with backing from CEO/CFO

• Set timelines • Ensure project remains on track with realistic goals and timelines • Weekly/Bi-Weekly project meetings

• Develop a process for maintenance • Ongoing review of chargemaster accuracy, data review, and usage trending

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K E Y C O N S I D E R A T I O N S F O R S T A N D A R D I Z A T I O N

Will the hospitals be standardized on the same billing/clinical system(s)? – Both the billing and clinical system affect standardization – Affects actual process and capture of the charges as well as how charges are processed – Can be accomplished on same or different systems (far more complexity)

Is there common leadership over similar departments across hospitals? – Requires leadership to work collaboratively for ultimate success

Migrate to best practice – Avoid converting hospitals to “chosen” hospital’s structure and processes – Instead move toward best practice and encourage adoption by all facilities

Charge masters can be completely standardized yet still maintain separate pricing by facility or other factors


O V E R A L L I M P L E M E N T A T I O N S U G G E S T I O N S

• Make critical decisions upfront • Pricing, Contracting, Billing/Clinical Systems, Leadership Roles

• Use pilot departments who are engaged and not adverse to change

• Identify ways to measure value and outcomes as project progresses • Encourage detailed financial analytics

• Use “parking lot” mentality to control scope

• Overcommunicate expectations, timeline and involvement of clinical departments

• Hold project leaders, sponsors and champions responsible for outcomes

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P R I C I N G C O N S T R A I N T S

• Academic, Urban, Rural, Community Hospitals merging into one Health System can be problematic

• How do you address pricing in a world of transparency & defensibility?

• How do you address varying cost structures, patient acuity and competition?

• How do you standardize charge master and charge structure in this environment and ensure net neutrality (or net revenue improvement)?

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S T R A T E G I E S F O R P R I C I N G

• Requires significant involvement and input from Executive Leadership regarding vision and strategy

• Where do you want to be in the market place?

• Are your Hospitals different enough to warrant different pricing?

• Do you Managed Care Contract restraints? And do they vary by facility?

• Do you want to be the low cost provider or have specific service lines that warrant being above/below market?

• Do you have reliable cost data?

• Do your variances in cost structure by facility make sense?

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S T R A T E G I E S F O R P R I C I N G

• Consolidated pricing across hospitals versus tiered pricing categories (i.e. rural, urban, academic)

• Consistent methodologies across Departments with varying mark-ups above cost (most effective in supplies, OR, pharmacy type departments)

• Consistent pricing methodologies are far easier to implement with consistent charge structure and departmental processes across facilities

• Consider phased approaches to updating prices (over 1-5 year period, staggering departments, etc.)

• Set floors and ceilings for changes and perform detailed analytics on net impact at a procedure, service line/department and facility level by each payor to fully grasp impacts

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C A S E S T U D Y – S I X

H O S P I T A L S Y S T E M


C A S E S T U D Y - S I X H O S P I T A L S Y S T E M

• Six hospital system • More than 17,500 employees and 4,600 credentialed physicians • 1,725 Hospital Beds • Annual volumes

• 200,000 Emergency Room Visits • 90,000 Inpatient Discharges • 8,000 Newborn Deliveries • 25,000 Inpatient Surgeries • 57,000 Ambulatory Surgeries • 10,700 Cardiac Catheterizations • 4,000 Coronary Angioplasties • 1,500 Open Heart Surgeries

• In process of migrating each of its six hospitals to new integrated EMR • Wanted to review charge capture processes and structure and standardize across

the Health System

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C A S E S T U D Y - S I X H O S P I T A L S Y S T E M

• Review identified the following initial variances: • Dramatic variances in Emergency Department acuity level assignment • Variances within peri-operative services to include Anesthesia, OR,

Recovery, Endoscopy • Variances in most other clinical departments across the Health System

relative to either charge master build and/or process

• Compounding factors: • Hospitals on different clinical systems • Varying payor mix, patient acuity and complexity of service offerings by

facility • Variances in leadership and executive presence

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S T A N D A R D I Z I N G C L I N I C A L D E P A R T M E N T S

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Operating Room/Peri-Op

•Standardized all facilities to a 5 level OR acuity system

•Developed criteria and worked with staff to assign levels, assess overall financial impact and re-price OR services by facility

•Standardized all facilities to same charge structure for anesthesia & recovery/PACU

•Criteria and policies/protocols developed

Labor & Delivery

• Inpatient •Standardized all facilities

consistent delivery structure

•Protocol developed/updated and implementation completed

•Outpatient •Standardized charge

capture and acuity level system for outpatients seen in the department

•Converted hospitals with varying charge capture methodologies to standard process

Endoscopy

•Standardized all facilities to 6 level acuity system for Endoscopy services

•Updated charge capture methodologies to align with peri-op changes for anesthesia and recovery

•Accommodated any additional processes required due to varying clinical systems


S T A N D A R D I Z I N G C L I N I C A L D E P A R T M E N T S

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Emergency Room

• Standardized all facilities to same acuity system being utilized by HIM

•Updated all charge master build and methodology of charge capture across facilities

Pain Management

• Standardized varying clinical and charge capture processes across facilities to align

Infusion Services

• Provided standardized charge methodologies and build of charge master

•One of the most complicated transitions based upon the varying processes across each facility and clinical department


R E S U L T S O F S T A N D A R D I Z A T I O N

• Consistent protocol utilization in Peri-Operative services to determine OR level assignment

• Improved charge capture of anesthesia and recovery services • Implemented consistent Labor and Delivery acuity structure for delivery charge

assignment • Consistent protocol utilization in Endoscopy for procedural level assignment • Standardized Emergency Department acuity levels with consistent criteria

utilized across all facilities resulting in stable ED bell curve system-wide • Improved procedural and supply charge capture in Emergency Department and

Outpatient Labor & Delivery • Improved supply and pharmaceutical charge capture in Operating Room, Labor

& Delivery, Endoscopy, and Pain Management • Improved accuracy of Infusion Services charge capture as direct result of

improved clinical documentation and education of training

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Q U E S T I O N S

C O N T A C T

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Stacey Harper Senior Manager (P) 412.613.0309 (E) [email protected]

Taylor Pedone Senior Consultant (P) 440.666.0930 (E) [email protected]

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NAVIGATING CHARGE MASTER STANDARDIZATION · 6/9/2015 · FINDING NEVERLAND: NAVIGATING CHARGE...

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Transcript of NAVIGATING CHARGE MASTER STANDARDIZATION · 6/9/2015 · FINDING NEVERLAND: NAVIGATING CHARGE...