Can You Document and Defend Your Chargemaster Prices Under the 2020 CMS Final Rule?
Since the October 1, 2015 commencement of I-10, both case mix index trends and CC/MCC capture rates nationwide have improved by 2.8% and 0.8% respectively.Years of coding and documentation training to address the tenfold increase in available codes and the need for improved specificity and documentation under I-10 appears to be paying off overall.
Restructuring of the hospital’s chargemaster in this era of transparent pricing often results in material increases and decreases in line item charges to align with market norms, unit costs, or a hybrid thereof. Learn how your organization can enhance its financial performance in this environment.
Hospital leadership responsible for achieving financial goals that include revenue growth, expense management, and operating margins is facing the growing importance of chargemaster integrity. We attribute the challenge of managing financial goals to the accuracy of charge data, complex systems impacting the ability to view the data, and the rapidly changing healthcare environment.
Payer strategies are evolving quickly, and healthcare organizations must be alert to make the most of revenue opportunities while mitigating claims denials. In light of recent denials and DRG downgrading by payers, how your organization adapts will profoundly affect your reimbursements. An organization’s own internal review can set the stage for monitoring and remediating any inappropriate downgrading of DRGs by the payer.