HIS Implementation:

Charge Data Mistakes & Safeguards

More and more hospitals are planning, in the process of, or regrouping from hospital information system (HIS) conversions. Surprisingly, we are noting a growing trend of inaccurate chargemaster (CDM) data left in the wake. This article highlights frequently encountered systems implementation mistakes that may be placing your charge data integrity at risk.

Common Implementation Mistakes

Despite the significant financial investment, hard work, and organization-wide commitment, HIS implementations often result in a surprising volume of data errors and confusion about functionality. Hospital leaders are often unaware of charge data errors introduced in the course of their systems implementations. Without appropriate analysis, CDM data errors can lie undetected in masterfiles for years and may even slip past billers, claims edits, or internally designed bill hold rules.

Charge data errors are often due to these mistakes that occur during system implementations:

  • Incorrect data is built in key masterfiles (perhaps from data entry mistakes, file upload errors, or adoption of unaudited data)

  • Key staff fail to fully understand system functionality or data relationships for interconnected applications

  • New workflow processes are created for charge capture and CDM maintenance

  • Masterfile ownership may have changed for those responsible for ensuring various cost-centers’ CDM data maintenance, auditing and monitoring of CDM data, or oversight of charge capture

  • Staff building and maintaining masterfiles were not fully aware of coding and payment systems rules or established hospital charging guidelines

  • System parameters and data fields aren’t understood or populated correctly; or, they are populated redundantly, leaving more data to maintain in the future (for example, multiple HCPCS or modifier fields)

  • Staff are unclear about the various functions or applications changing or overriding charge data

  • Because of implementation timelines and file build deadlines, charge data masterfiles haven’t been maintained quarterly to meet HIPAA transaction code set standards for “hard-coded” data (CPT-4, HCPCS Level II, modifiers, etc.)

  • Changing regulations and payment system rules aren’t monitored for their potential impact on masterfile data (status indicators, payment indicators, edits, etc.)

  • Incorrectly populated charging masterfiles (chargemaster, pharmacy system, etc.) may contain errors that slip past “high-level” automated file analysis

All of these implementation mistakes carry significant risk to a healthcare system’s charge data integrity and can undermine years of strong chargemaster management. Such oversights and errors are more common when hospitals face short installation timeframes, lack information systems expertise, make poor strategic decisions, or fail to have the correct personnel involved in HIS decisions.

Many of these mistakes can be resolved in a short timeframe with effective auditing tools, input from your HIS vendor’s application experts, and strategic help from chargemaster experts. Let’s talk about some actions that you can take today to reduce charge data compliance and revenue risk caused by implementation mistakes.

Charge Integrity Safeguards

The goal of all revenue cycle teams is to ensure ongoing charge data integrity despite other organizational initiatives. A systems installation is no exception. The landscape of charging data and payment systems is constantly changing. Because of this, remediation of potential charge data risk needs to always remain a priority.

The following actions can ultimately safeguard charge data for assured compliance and revenue integrity before, during, or following an information systems installation project.

  • Solicit Feedback

    Give charge management and key revenue cycle team members the opportunity to participate in workflow redesign that impacts charge data. While they may not be on the information systems implementation team, they can provide valuable input on charge data and compliance requirements.

  • Conduct Training

    Ensure that your team fully understands the new system’s applications, priority masterfiles, key data elements, field functionality, systems parameters, and reporting related to charging masterfiles. Although many rely on their information technology department and applications-specific personnel, the revenue integrity and chargemaster teams should be aware of the overall systems landscape to serve as appropriate stewards for long-term charge data integrity.

  • Define Ownership

    Define appropriate owners and internal advisors for each cost center’s charge data file development and charge capture processes. While departments may be focusing on clinical and technical files, the in-house chargemaster advisors can ensure the correlating charge data is compliant.

    ChargeAssist® customers can use the comparison module to aid in system synchronization and run comparisons throughout the file building process. The charge change module and document center can be used to communicate on the new as well as the existing CDM file if so desired. These modules allow the Charge Management team to stay involved in communications about regulations, charging rules, charge data maintenance, and auditing throughout the conversion process.

  • Collaborate on Conversions

    If entering into a corporate or “community-based” system implementation, confirm how the new charges and your legacy CDM’s charges will differ. Collaboration on conversion issues is even more critical than in a traditional single hospital implementation. Examples of important charge data decisions include:

    • Charge description rules and standards
    • Department-specific CDM content
    • New charge capture methods
    • Changes to charge structure
    • Revisions to coding assignment
    • Different masterfiles to drive claims data
    • New claims editing rules that will modify charge data

  • Address Potential Impact on Pricing

    Develop a proactive strategy for addressing the conversion’s potential impact on pricing. This is vitally important for cost centers with changing charge structure or coding components such as Surgery, Cath Lab or Interventional Radiology. Teams can use tools like ChargeAssist® to model new chargemaster pricing against a variety of pricing benchmarks. Our customers are now evaluating their charges against a variety of hospitals’ and regions’ pricing, as well as against various pricing data now available for physician practices, reference labs, imaging centers, retail pharmacies, and other provider settings. There’s no need to wait for a formalized pricing study to shore up rates when the data is available as your files are being built.

  • Document New Processes

    Create charge data flow charts, schematics, and documentation of systems functionality and distribute to all staff impacted by the changes (including revenue cycle and CDM teams). Detailed documentation of new processes will reduce surprises and potential risks to revenue. This is especially important for departments converting from a straightforward charge entry process to charging driven by alternative applications. Remember that any outsourced companies involved in coding or charging will also need to be involved in these discussions.

  • Clarify Rules

    Ensure that CDM and revenue cycle team members are clear on reimbursement and coding rules when adopting new providers or service lines within your new systems environment. Our customers refer to the ChargeAssist® Document Library’s Medicare Manuals, AMA’s CPT-4 guidelines, NCCI manuals, and a host of other supporting materials when their organizations begin new services.

  • Manage Charge Data

    Manage charge data throughout the systems implementation timeframe. Coordinate with the IT systems conversion team on their file build timelines, data freeze requirements, and other implementation milestones. You’ll need to ensure that both legacy and new systems will be supported for mandatory updates and reporting such as CDM quarterly data updates, pricing updates, or charge data submissions to state agencies.

    CDM tools like ChargeAssist® support ongoing management as well as conversion activities. Consider using the product for monitoring both your existing as well as your new “in development” files even if moving to a shared system with other hospitals. This is especially important if crossing over an annual coding and regulatory update timeframe during the conversion.

  • Encourage Interdepartmental Communication

    Strive for collaborative yet efficient communications between hospital personnel, vendor staff, consultants, and others. CDM and revenue cycle teams are key players in systems installations, as they can bring to the table knowledge of past and current charge management decisions, chargemaster data guidelines, charging rules, policies, protocols, and procedures. It’s important to include them in strategic planning even when they may not be on the systems conversion team.

  • Provide Effective Oversight

    Even if others may be in control of future file maintenance and data updates, it’s your responsibility to ensure that your facility’s charge data results in accurate claims. That may mean some redundancy in monitoring and auditing for a little while. A chargemaster auditing tool will support data monitoring, eliminate subjectivity, and simplify auditing and monitoring. A coordinated process with new chargemaster owners will ensure your established commitment to charge integrity is upheld.

Prepare for Disruption

There’s a lot at stake in systems conversions. Implementation mistakes can introduce unanticipated risk to charge data integrity, billing efficiency, claims data compliance, and ultimately, financial performance. Inadvertent errors in charging or coding data can result in significant repayment penalties, fines, and compliance challenges. Whether your hospital is post-install, midway through, or still in the planning stages, the operational safeguards we’ve noted in this article can help protect your organization’s charge data integrity.

It’s important to remember that a systems conversion can cause significant operational disruption despite proactive planning and ample staffing. We encourage our revenue cycle and chargemaster colleagues to serve as the advocates for charge data integrity. Talk to other hospitals to learn about their implementation and vendor experiences. Collaborate with other chargemaster managers to prepare for new functionality that may change your current processes. And, importantly, plan to use all available resources (such charge management tools or consulting expertise) to complement the conversion process.