10 Steps for Failsafe Charge Data Management
10 Steps for Failsafe Charge Data Management
#1 Define Charge-Oriented Data Flow & Processes
Charge data and Charge Master management processes are complex and impact nearly every operational department of a hospital. Data relationships, defaults, and overrides are frequently misunderstood. It is important to know which information systems impact charge data flow. Consider activities required to capture data as well as activities that are necessary to maintain master files.
#2 Identify Risks
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 risk in advance of problems and address these areas proactively.
#3 Coordinate File Update Tasks
Many hospitals are unaware of the scope and depth of Charge Master updates. They may fail to address all critical issues or data updates. CDM file changes occur continually. Master file updates for the Charge Master 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. 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. The following tasks help manage file updates:
- Develop a plan
- Prepare thoroughly for annual and quarterly updates
- Ensure correct data through targeted audits
- Receive education on coding, payment system, and regulatory updates
- Obtain appropriate and accurate data and resources
- Conduct internal department working sessions or internal in-servicing on changes
- Coordinate all data update activities to ensure implementation by the effective dates and accuracy with file charges
#4 Develop a Charge Data Monitoring Plan
Charge capture, coding, and CDM errors can produce significant risk that can be repeated over many years if undetected. Hospitals can avoid this risk by creating a long term, ongoing charge master/charge data monitoring plan that includes the following:
- 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 alternative committees such as Compliance and Revenue Cycle.)
- Based on monitoring results, build action plans for more extensive auditing, research, in-service education or process improvement
#5 Select a CDM 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 involved in charge capture. We have found that today’s charge data management exceeds far beyond basic CDM file maintenance tasks of the “CDM Coordinator” role of the past
If CDM Management Duties are Already Assigned
Confirm who owns various, charge data management responsibilities. Evaluate the priority tasks, time required, and performance of charge management duties. Many hospitals transform their process improvement simply through refining and properly organizing the CDM Management duties.
If No CDM Management Duties are Assigned
Charge data and CDM management tasks must be actively monitored. If duties aren’t assigned, there’s no assurance they are being performed, and correcting errors at claims processing is inefficient and risky. Outline and prioritize management duties and meet with your team to confirm the level and quality of ownership of all tasks. Defined organizational charge data management objectives will significantly help in the recruitment, interviewing, and placement of staff in the management position. Decide whether one or multiple parties should take responsibility for priority duties. Determine whether existing personnel have the basic skills, knowledge, and time to dedicate to the priority tasks. If an FTE position is deemed practical, consider these criteria:
- Skills: Candidate should have experience and skills in project management, data maintenance and auditing. They should also show expertise in narrative report development, collaboration and diagnostic data analysis.
- Knowledge: Candidate should have knowledge of the basics of CPT® and HCPCS Level II code sets and rules, Revenue Codes, claims data elements and rules impacting their use, proficiency in researching Medicare and AMA resources, ability to understand your unique HIS systems’ data and processes that relate to charge data
- Experience: Ideal candidates are often internal staff and can be trained in Charge Management skills. Unless there are specific organizational goals, seeking only those with CDM management job experience may limit the hospital’s search, and exclude strong candidates. If your system is undergoing specific initiatives or projects (such as: HIS System Conversion, CDM Standardization or Consolidation, Multi-Hospital Corporate CDM Management, etc.) integrate the unique skills requirements into your search.
- Time: CDM Management tasks vary by organization and often evolve. Many CDM Manager positions are full time and may even require support staff in larger organizations.
Look both internally and externally for candidates. With the right knowledge, internal candidates can be trained in key skills for charge data management, and have the advantage of knowing your environment and key personnel. If no qualified candidates emerge in your recruitment process, reassess the applicants, and consider training.
#6 Seek Administrative Buy-In
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 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 CDM management, these expectations need to be integrated into the overall plan. Developing administrative buy-in before there are immediate needs expedites 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 Management Team
Effective charge data management relies on key representatives from hospital revenue cycle, compliance, patient accounting, coding, information systems, decision management, and other operational support areas. 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. A team structure provides a forum to discuss revenue and compliance-related charge issues.
#8 Involve Department Representatives
Hospitals face significant risk of claims errors without department involvement in charge capture and data verification. Typically, CDM department representatives are the individuals who truly understand the diagnostic and therapeutic services their departments provide. Good collaboration with departments will ensure correlation of services with charge data and a more complete understanding of charging guidelines. 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, & integrated data and regulations
- Tools for performing the assigned tasks
- Support and assistance
- Methods to ensure accountability
#9 Budget & 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. (H&A provides a Charge Management Resources worksheet listing these materials. Contact us if interested in a copy.)
#10 Perform Retrospective Process Assessments
Ongoing assessment of your organization’s unique CDM Management processes allows benchmarking and clear indicators of performance. The most basic assessments include:
- Documentation of auditing, monitoring and CDM update activities
- Evaluation of internal processes
- Assessment of staff performance of responsibilities
- Surveys and Interviews on Charge Management support needs
- Development of an action plan for improvements
- Implementation of tasks for Charge Management improvements
- Routine reporting to Administrative representatives or applicable committees
Holliday & Associates offers ChargeAssist®; an HFMA Peer Reviewed® Charge Master auditing and resource tool for easily auditing, collaborating, and maintaining Charge Master files. We also provide Charge Management Team and Charge Master Coordinator Educational Programs as well as customized CDM Reviews by a team of credentialed clinical, coding and technical auditors.
Visit Holliday & Associates web page for details on software functions and consulting services here: https://www.chargeassist.com/chargeassist/
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