Fear of Failing: Annual CDM Update Mistakes You Can Avoid

She’d been on the job just two short weeks.

Hired at the most prestigious health system in the region, and already on the brink of a major Revenue Cycle catastrophe. Claims were clearly going to error for every patient account that had charges needing January 1st CDM revisions.

Looking back, the writing was on the wall even during the initial interview. She was told that the hospital had no real CDM Management structure to speak of. The last Coordinator told the CFO “the CDM updates weren’t quite ready”. (Actually, the process was never truly started.) Our heroine said “No problem…I’ll put things back on track.” The job was hers.

Week one…She found that there were no CDM tools and CPT publications hadn’t been ordered for numerous areas. IT wasn’t 100% sure about the CDM file’s multiple code fields and payer-specific mapping. Patient Accounting didn’t have documentation of claims overrides impacting charge data. Billers said they “fix whatever errors out”, but didn’t have notes, logs, or clear protocol for making claims data changes. Coding was in a backlog situation and didn’t have time to sit in CDM meetings.

Week two…The department orientation meetings revealed even more problems. . The Behavioral Health manager became emotional about how 2019 coding changes would be hard map to the 2018 codes. Lab said ‘my system is always correct… just don’t worry about the outdated charges in the CDM’. Pharmacy didn’t understand why they needed auditing of their pharmacy HCPCS coding saying the file was “sensitive information”. No one reconciled charge capture; and most departments only focused on ancillary applications or order menus. Things weren’t looking good.

Thinking it was probably not the best time to cause a stir; she dug in and decided to update the CDM herself.

…It’s December 31st… down to the wire…. Despite her hard work, missed holidays and late nights at the office, time had run out. The Coordinator wouldn’t be able to finalize all the changes in time. She had to come clean and let her CFO know.

The most indispensable lesson she’d ever learned about overconfidence was now tattooed in her mind. How could she avoid this again? What would she say to Administration to keep their trust?

This Coordinator’s experience may sound familiar. Even in the nearly unreasonable amount of time, the organizational status quo should have been disrupted. Year-end CDM readiness could have been attained with the right tools, resources, and teamwork.

CDM Update work is complex and the focus shifts annually. It requires proactive planning, collaboration, and strategies. The CDM Coordinator (whether FTE or as a shared duty) must not only be smart – they must lead.

If you’re relatively new to Charge Master annual updates, this “Top 5 Mistakes” list below may help. With the right tools, you can avoid our Coordinator’s* state of affairs by considering these suggestions.

*Disclaimer: This story’s character is in no way meant to represent any individual or organization. She is a fictional compilation of what we see, hear and know.

Top 5 Mistakes:

#1 Avoid Repeating Blunders from the Past

No one wants to make mistakes with CDM updates; much less, the same ones year after year. As the new year’s update information is released, many hospital teams repeatedly are caught off guard with one or more of these operational challenges:

  • Waiting too late to plan for all necessary CDM update tasks
  • Implementing changes and later learning that the original data was inaccurate or inactive
  • Relying solely on replacement code recommendations without fully understanding code changes and rationale
  • Asking HIM Coding alone to be in charge of CPT changes in absence of Departments or Revenue Cycle support
  • Expecting IT to change Charge Master & other applications’ masterfile data prior to evaluating payment system or edit changes
  • Finalizing file revisions before all data is available
  • Enabling Departments by doing CDM update work for them
  • Failing to consider how pricing or charge capture may change with code or payment system revisions
  • Underestimating time required to update charging tools, forms or systems used to drive charge capture
  • Not considering payment or status indicators and ultimately populating files with incorrect codes
  • Only focusing on code-specific changes linked to your CDM file
  • Repeatedly allowing CDM updates to be late, and manually correcting claims for an extended period

#2 Don’t Skip Important Information

Often CDM Coordinators need to educate their department managers as well as hospital leaders on the importance of complete reference sources for the new year. Plan your organization’s resources inventory now and if the budget is short, ask for emergency funding. The cost will pay for itself in saved payment errors and lost productivity. Beyond quality CDM tools (which may fulfill your organization’s needs), individual priority resources include the following publications and data sources:

Publications Your Team Should Review (September-December)

  • AMA publications
  • CPT Manuals
  • CPT Professional or Standard Edition
  • CPT Changes (in ChargeAssist)
  • CPT Assistant(in ChargeAssist)
  • Errata and other CPT educational content
  • HCPCS Level II references (in ChargeAssist)
  • Medicare Publications
  • Transmittals & MLN Matters Articles (in ChargeAssist)
  • Medicare Manual Updates (in ChargeAssist)
  • Federal Register Final Rule publications for primary payment systems (in ChargeAssist)
  • National Correct Coding Initiative (NCCI) Manual (in ChargeAssist)

Data Your Team Should Review (September-December)

  • Licensed codes, payment system, and edit data files (in ChargeAssist)
  • CPT codes from AMA
  • HCPCS Level II Files from CMS
  • ADA Dental codes (if applicable)
  • Local payer codes
  • Payment System files (OPPS, MPFS, DMEPOS, Laboratory Fee Schedule, etc.)
  • Relative Value Units
  • Pricing, Payment, or Status Indicators
  • Edit Files (ex. Medicare Outpatient Code Editor)
  • Code-specific OCE edits
  • NCCI & MUE Edits
  • Coverage Indicators (in fee schedule files) and LCD/NCD
  • Charges with associated CDM Code changes (in ChargeAssist)
  • All code and payment system changes (even if you don’t have them in your CDM) (in ChargeAssist)

These are only a few examples of the annual and quarterly CDM update information that your hospital and practice management team must consider. This information will ensure a complete understanding of the upcoming data releases.

#3 Always Consider Payers & Payment Methods

We have seen department representatives look with disbelief when they learn that an expensive seminar, publication, or manufacturer document provided incomplete or inaccurate information. Remember that professional fee and facility fee rules and payment methodologies vary. Often, what works for one provider or payer type will be inaccurate for the other. Know your payment systems now to properly interpret the new year’s changes. (An internal in-service or H&A mini-educational program on payment and status indicators may be the trick to resolving this challenge.)

#4 Use Tools in Tandem with Education & Reference Materials

As a tool provider, you’d think we would say “use our tool and all will be well”. This can be no further from the truth. We watch hospitals struggle year after year when they believe a simple file update is all that’s needed for year-end Chargemaster preparation…all because a vendor told them it would. Annually, we remind our customers that simply reviewing code books or code change worksheets from tools is only part of what has to be done. Be certain you’re developing a plan with all critical components: education on the new rules and codes, check list of all masterfile updates, revisions to charge capture protocol, and pricing changes when needed.

#5 Ask For Help

This is sometimes the hardest thing to do. Many new Chargemaster owners are either too busy with other priorities or may not be aware of the depth, scope and detail surrounding their CDM file management. Asking for help can be as simple as engaging a trusted consultant to walk you through the updates and help with challenges. H&A will be providing our prerecorded CDM Update webinar and in-depth update manual in December. We also provide web meetings for last-minute consulting help until the schedule is filled. In today’s remote support world, targeted consulting help has saved countless hospitals from making grave errors with annual CDM updates.

The Moral of our Story

While often overlooked and underappreciated, the Chargemaster management position is a highly complex job when performed correctly. The CDM leader must understand the complexity of information systems, have strong interpersonal skills, interpret sometimes abstract coding and regulatory guidelines, and support the organization’s pricing and budgetary objectives. Good coordinators known their Revenue Cycle peers are vital allies, and departments are the best choice for interpreting the clinical and technical nuances of correct charge data choices.

Proactive Coordinators are ready: They know that rules, payment systems, services, and charge data will all change. It’s an ongoing process requiring constant attention despite other organizational priorities. If your CFO, Revenue Cycle Team or Department Managers aren’t on-board with year-end CDM updates, share our story. If you need some outside expertise, call us and we can discuss a strategic call or an easy-to-understand Charge Management orientation webinar or software demonstration. And don’t forget the Annual CDM Update Streaming Webinars are perfect for team training on chargemaster changes.

The author’s direct e-mail is rholliday@chargeassist.com and phone is (530) 550-0865.

Reference and Related Posts:
10 Steps for Failsafe Charge Data Management – Holliday & Associates
Holliday & Associates Charge Management Software Solutions
ChargeAssist HFMA Peer Review Renewal Press Release
ChargeAssist Charge Master Public Portal Press Release

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.

Contact information: (800) 831-3323 | Website: www.ChargeAssist.com | info@chargeassist.com

Visit Holliday & Associates web page for details on software functions and consulting services here: https://www.chargeassist.com/chargeassist/

Copyright © 2019 Holliday & Associates All Rights Reserved

Details on HFMA Peer Review®  – ChargeAssist® HFMA Peer Review Renewal Press Release