10 Steps for Failsafe Charge Data Management
Busy revenue cycle teams often overlook the basic steps of charge data management to attend to more urgent priorities. The proven steps covered in this article are pivotal to keeping “charge data management” a key operational priority.
Successful deployment of the tasks required for each of these ten steps results in lasting quality and more efficient teams. By taking the initiative to proactively improve your charge data management practices, you will join other CDM leaders who have confidence that their hospital is prepared for the ongoing challenges ahead.
1. Define Charge-Oriented Data Flow and Processes
Whether performed by chargemaster or revenue cycle staff, charge data management processes are often complex. These activities impact nearly every operational department of a hospital. What’s more, critical data may be generated from multiple systems and applications. Data relationships, defaults, and overrides are frequently misunderstood.
It is important to know which information systems impact charge data flow. Check with your information technology staff to see if an information systems schematic has been developed. If not, identify the information systems, software applications and data elements that impact charge data.
Next, align all work processes that are involved in charge data processing with the various systems. Consider activities required to capture data as well as activities required to maintain master files.
Flow charts and decision trees often help teams understand data relationships and processes. Hospitals tell us that knowledge of data flow and processes saves countless hours troubleshooting issues, solving problems, and improving processes.
2. Identify Risks from Redundancies & Weaknesses
As noted in Step #1, charge processes can be complicated and extensive. Frequently, problems arise because hospitals are unaware of potential issues. When systems or work processes are redundant or weak, hospitals may be caught off-guard by a cascading volume of errors at the worst of times.
The goal of effective charge data management is to identify risks in advance of problems and address these areas proactively.
3. Coordinate Master File Update Tasks
Many hospitals are unaware of the scope and depth of charge-related master file updates and, subsequently, fail to address all of the critical elements. CDM file changes occur continually- Master file updates for the chargemaster and other related files occur throughout the year as services and inventory change. Quarterly updates, corrections and changes to multiple systems (required by HIPAA Transaction Code Set standards) require attention as well. Annual changes effective on January 1 are the most comprehensive. They reflect large volumes of CPT® and HCPCS Level II code updates, outpatient payment system changes and revisions to claims edits. There are many considerations required to manage these updates and to ensure accuracy within all applicable master files.
The following priorities are key to managing master file updates completely and accurately:
- Develop a plan
- Prepare thoroughly for annual updates
- Ensure correct data through charge data integrity audits
- Receive and perform education on updates
- Obtain appropriate and accurate data & resources
- Conduct internal department working sessions
- Coordinate all implementation activities
4. Create a Charge Data Monitoring Plan
Charge capture, coding and CDM errors can produce significant risks that can be repeated over many years if undetected. Hospitals can avoid this risk by creating a long-term, ongoing CDM monitoring plan. This plan may take various forms and may continually change its focus.
Monitoring should incorporate evaluation of data accuracy along the continuum of charge capture and claims data as well as within specific master files. A key focus for ongoing monitoring includes the continually changing data within the chargemaster file.
Personnel involved in charge data monitoring programs may vary. Some hospitals rely on the CDM coordinator alone, while others prefer a team approach. The teams can be a CDM team, revenue cycle subcommittee, compliance subcommittee or other established audit/monitoring group. If your hospital outsources CDM file maintenance to a third party or corporate office, remember that hospital-based monitoring is still necessary. As the provider and point of service, your facility may have to defend challenged claims data.
- Ensure the accuracy of all significant master file updates with quality control checks.
- Evaluate charge capture accuracy for areas significantly impacted by annual or quarterly updates.
- Monitor sample claims, chart documentation and detailed charges for targeted services/areas (focus on problem areas that are prone to charge capture or claims data errors).
- Monitor error reports that reflect charge data.
- Collaborate continually with key billers to identify claims processing issues they encounter.
- Watch for corrections, errata, and changes from CMS, AMA and other sources. Updates are typically released mid-January, but some have been released as early as December.
- Monitor department “climate” to ensure appropriate representatives are engaged and supportive of charge and claims data integrity initiatives.
- Document and report monitoring results to appropriate directors and administrators. (Results may also be incorporated into one or more committees in the hospital.)
- Based on monitoring results, build action plans for more extensive auditing, research, in-service education or process improvement.
Monitoring programs dovetail with many required elements of hospital compliance initiatives and fit well into many revenue cycle improvement programs. At best, they instill confidence in the hospital charge data integrity programs. If problems are uncovered, they support the escalation of issues before they become serious. Their flexibility and changing nature contrast the structure of file update tasks and complement your overall charge data integrity program.
“New initiatives, reorganization, and system conversions in today’s healthcare environment can derail even the best chargemaster controls. Attendees of our Chargemaster Management Educational Program have confirmed that staying true to these ten areas helps them achieve more proactive oversight of CDM Management processes. And we agree. ChargeAssist® quantitative results show dramatically-reduced charge data compliance risks and improved charge data integrity in just a few short months of formalizing a charge management improvement program.”
—Rosemary Holliday, Executive Vice President at Panacea Healthcare Solutions
5. Select a Charge Data Manager
Charge data management requires vigilant oversight of a great deal of data and, often, complicated systems and processes. Interpersonal factors are equally important because of the large number of personnel and manual interventions required for consistently accurate charge data.
Clearly, today’s charge data management exceeds far beyond basic CDM file maintenance tasks of the “CDM Coordinator” role of the past.
How do hospitals assess charge data management needs and staffing? Consider these perspectives for 1) hospitals with, 2) hospitals transitioning, and 3) hospitals without charge description master and charge data management duties assigned:
6. Seek Administrative Buy-In for Initiatives
Even the best strategic plans fall short without the support of administrative representatives. These are the individuals who can escalate issues, authorize budget changes, support the adoption of key objectives of your plan and approve the integration of tasks into job performance criteria.
Typically, administrative representatives desire high-level updates on charge data management (issues, status, severity and impact). If administrative team members have different visions or goals for chargemaster and revenue cycle management, these expectations need to be integrated into the overall plan.
Developing administrative buy-in before there are immediate needs expedites the resolution of issues. Additionally, administrative support of your charge improvement program will make a considerable difference for software implementation/conversion projects, charge-related consulting engagements, revenue cycle initiatives, compliance program expansion, audit defense or other major projects.
7. Form a Charge Data Team and Assign Roles & Responsibilities
How quickly does your hospital uncover and solve problems with charge data? Effective charge data management relies on key representatives from hospital finance, compliance, patient accounting, coding, information systems, decision management and other operational support areas.
This multi-disciplinary aspect is often bypassed, and operational “silos” form. The result is often a patchwork of fixes to claims data, code assignment discrepancies and unexpected errors with charge data.
The “Team” concept has proven successful in hundreds of hospitals nationwide since it brings together the appropriate parties in an organized forum to resolve issues. The charge data team offers a forum to discuss all revenue and compliance-oriented issues that relate to charges. This often resolves longstanding issues that may otherwise require months to resolve.
8. Include Appropriate Technical and Select Clinical Department Representatives
Hospitals face a significant risk of claims errors without department involvement in charge capture and data verification. Typically, department representatives are the individuals who truly understand the diagnostic and therapeutic services they provide. Good collaboration with departments will ensure a better correlation of services with charge data and charge capture requirements.
The key to engaging department representatives is to provide:
- Orientation to the tasks they need to perform
- Education on the data elements they must understand
- Access to timely, complete and integrated data and regulations
- Easy tools (and training on tools) for performing the assigned tasks
- Support and follow up
- Methods to ensure accountability
9. Budget and Use Resources Wisely
Many hospitals are unaware of the numerous resources needed for effective CDM and charge data management. Seek guidance from peers or trusted consultants for realistic forecasts of expenses. When appropriate, reevaluate costs and market options to be sure your funds are wisely spent.
10. Perform Retrospective Process Assessments
Ongoing assessment of your organization’s unique chargemaster and revenue cycle management processes allows benchmarking and clear indicators of performance. The most basic assessments include:
- Documentation of performance of auditing, monitoring and CDM update activities
- Evaluation of internal processes and staff performance of responsibilities
- Development of an action plan for improvements
- Implementation of steps for improvements
- Reporting quantified improvements to administrative representatives or applicable committees