Chargemaster Spring Cleaning Tips

It’s time to revisit your organization’s charge management priorities now that the busy first quarter is behind us. Here are seven easy “spring cleaning” tips that result in dramatic, strategic improvements. We hope they serve as good discussion-starters for your team.

As always, we also encourage you to make use of materials in chargemaster software and educational programs and seek out industry experts for more improvement ideas.

  • Identify Charge Management Priority Issues

    All chargemaster teams tell us they face a constant barrage of urgent, priority tasks. They routinely balance immediate requests with longer-term projects.

    Nobody likes working in a reactive environment. Take control by identifying your organization’s current high-priority charge management issues. Start by noting how you spend your time with basic data maintenance and claims-related issues. Next, log the activities you’re spending time on throughout the course of a week.

    Consider what initiatives other hospitals are focusing on (see list below).

    Now that you have some ideas, create a comprehensive list of potential charge management initiatives for the upcoming year. Next, refine your team’s list by focusing on the most critical charge management activities.

    Obtain buy-in from hospital leadership to ensure your team’s priorities are acceptable. Ensure that all in management and administration are aware of charge management priorities and the anticipated time it may take to perform the related activities.

    Schedule projected dates for each of your highest priority charge management activities selected for the coming months.

    This tip is first because we feel it’s most important. Defining priorities and gaining consensus can dramatically improve not only performance but also staff morale.

What are other hospitals doing?

  • Developing new CDM sections for new medical services or providers
  • Performing compliance-oriented chargemaster audits (either house-wide CDM reviews or department-specific audits)
  • Conducting CDM improvement projects:
    • Medicare self-administered drug compliance
    • HCPCS and drug billing multipliers
    • Protocol for billable supplies
    • Implanted device HCPCS codes
    • Supply HCPCS coding for commercial or Medicaid plans
  • Reviewing files for potentially missing charges or codes
  • Running synchronization audits of chargemaster files against select ancillary application masterfiles
  • Assisting in rebilling/reprocessing claims due to changes in Medicare rules

  • Understand Organizational Influences

    It’s hard to embark on charge management improvement tasks when higher-priority, organization-wide initiatives sideline your progress.

    Once you are clear about your team’s priorities, it’s wise to identify charge management priorities coming from organizational directives, large-scale projects, or various service line owners’ operational needs. Be certain your team is aware of any anticipated organizational challenges such as budget freezes, cost reduction initiatives, data freezes, hiring freezes, layoffs, outsourcing plans, etc.

    Many hospitals have long-range, high-priority initiatives underway, such as:

    • System conversions
      • Chargemaster standardization
      • Multi-entity CDM consolidation
      • File and menu building
      • Charge management policies and protocols
    • New workflow processes for charge capture, billing or coding
    • New entities, service lines, or outside service charges (e.g., reference labs, etc.)

    And, of course, ongoing initiatives:

    • Budget
    • Hospital pricing updates
    • Compliance program mandates for auditing & monitoring

    Today’s hospitals face various initiatives that can affect even the best team’s performance. Avoid undermining performance or morale by seeking consensus on charge management priorities. Then, if larger-scale initiatives are introduced, know how to adapt quickly by revisiting priorities.

  • Create a Spring & Summer Charge Management Plan

    Nearly every hospital is attentive to CDM issues in the first and fourth quarters. What about the rest of the year?

    Changes to annual payment systems, coding, and regulatory updates keep every chargemaster team busy at year-end. Many find they are still in troubleshooting mode for weeks after the first of the year. Throughout the year, Medicare also releases quarterly changes, corrections, and new guidelines that must be addressed. These ongoing matters can’t be disregarded and demand attention for assured chargemaster and claims accuracy.

    We find that many hospitals overlook or fail to recognize significant gaps with charge data controls, charging protocol, monitoring activities, policies, and other various charge management processes. Many organizations also face shortcomings with education and staff development necessary for charge management and claims integrity.

    Rather than waiting to address all chargemaster issues at year-end (as many do), consider dedicating time now to develop a plan for the next few months.

  • Refocus

    Set aside several non-essential tasks for a few days to realign your priorities and schedule.

    Sometimes professionals need a spring break from their day-to-day routine. Take a short sabbatical from a few activities that bog down your day. Consider whether you can use this free time to develop process improvement ideas.

    The most common challenges facing charge management and revenue cycle teams include urgent requests, short deadlines, tedious data work, difficult payment systems, regulatory challenges, or organizationally-driven problems. Accomplished professionals realize that balancing these priorities with their own priority work tasks is the key to sanity and success.

    In our busy days doing research, data analysis, and meetings, it’s easy to feel like we’re working harder but not smarter. Refocus for a change of perspective, and evaluate your organization’s charge management on deeper operational level.

Tips to Improve Focus on Charge Management

  • Identify your hospital’s goals (if any) for achieving and sustaining organization-wide charge integrity.
  • Consider operational structures, departments, & staffing for functions such as chargemaster management, charge auditing, systems integrity, or broader revenue cycle operations.
  • List day-to-day activities intended to ensure accurate charge data.
  • Rank each task’s priority both for yourself and for the greater organization in general.
  • Grade you or your team’s performance of each task.
  • Evaluate the ranking and grading as a team:
    • Develop consensus on top priority, urgent tasks.
    • Confirm how much time is allocated to priority tasks, and how much time remains.
    • Identify which tasks are consuming an unbalanced amount time in relation to their benefit or results.
    • Create a revised charge management priority list.
  • Confirm whether the right people are responsible for the correct tasks.
  • Decide whether your team has the time, skills, and knowledge for the activities required.
  • Plan next steps.

  • Reassess Your Team

    Many chargemaster and revenue cycle teams experience staffing and organizational challenges that distract them from focusing on process improvement.

    Jobs change, responsibilities evolve, and personnel come and go. Chargemaster management may be a current department, an full-time equivalent position, a shared job responsibility, or merely an operational priority.

    Sadly, in some organizations, past chargemaster or charge integrity initiatives have often fallen by the wayside.

    It may be time to evaluate your team’s charge management oversight effectiveness.

    • Consider responsibilities, priorities, staffing, and leadership
    • Note the active, successful, and well-intentioned charge improvement commitments
    • Identify obstacles or other priorities that have interfered with successful oversight

    With team consensus, it’s easier to establish goals for charge management processes. With some dedicated effort, your team can be on the path for quick and dramatic improvements.

  • Improve Ownership by Providing Education

    It’s sometimes hard to garner enthusiasm for charge management when the topics seem esoteric.

    When kicking off charge management improvement initiatives, remember the importance of good communication. That may mean first defining basic terms, concepts and data relationships. Next, hospital personnel may need orientation, training, and focused skills improvement.

    Orientation and basic charge management strategic sessions greatly enhance department representatives’ abilities to effectively support charge integrity objectives. Some basic training in targeted aspects of CPT-4 & HCPCS Level II coding, charge protocol, or reimbursement can dramatically improve department buy-in.

    Quick collaboration will be essential whenever there are new CDM team members, hospital leaders, or department representatives. Determine the necessary level of orientation for new personnel. Evaluate whether they need core charge management training, systems training or simply, more help understanding your organizational priorities and their responsibilities.

    Our customers have proven that regular strategic working sessions consistently improve an organization’s long-term charge integrity, compliance, and payment accuracy. Develop a consistent communication plan through manager meetings, e-mail, phone calls, special working sessions, or communication through your charge management software.

Make Training Sessions More Fun

Consider a unique meeting location to mix things up. Perhaps your team can set up a strategic session as an outdoor meeting, a working lunch, or by gathering at your hospital coffee shop to change the environment.

Use some creativity to entice attendees to show up, and keep them interested in your sessions (cheap door prizes, drawings for an inexpensive item, snacks, etc.).

Recognize each participant’s value to your overall goals and engage them in topics they can relate to.

Apply good meeting etiquette: Invite the correct attendees, avoid excessive rescheduling, have an agenda, stay on task, and begin/end meetings on time.

Be sure to bring the right materials for working sessions (reference materials, reports, equipment, pens/paper, note cards, poster boards, etc.)

Finish every meeting with a firm agreement on follow up. Document working session outcomes and issues. And most importantly…thank your team for their time (even if you’ve done all the work).

  • Begin Now

    Just like in nature, spring is a time for new beginnings. Start your charge improvement plan now if you’re serious about improvements.

    For most hospitals, April and May are typically the best months for starting projects or introducing initiatives.

    At the next revenue cycle meeting, introduce your ideas for spring improvements. Once everyone is in agreement, schedule priority meetings and stick to a committed path.

    Use this article for ideas as you craft your own team’s goals, objectives, and priority list.

    And finally, be realistic and don’t let a few bumps in the road derail your entire improvement plan. Work through changes.