Annual Update Processes:
Build a Work Plan that Really Works

This is another article in our Annual Update Process series, designed to help with your health system’s Charge Master and other masterfile update plans for year-end.

Proactive teams have already begun 2018 update planning. They have used our earlier articles for tips on planning, staffing, and researching their internal environments for the update tasks ahead. Our customers have also begun reviewing 2018 CPT-4® updates over the last two months.

This article discusses basic suggestions for getting started with the annual update project plan.

Work Plan Tips

A well-defined project plan will keep your team organized during the busy annual update timeframe over the next 60 days. Here are some basic steps for creating your plan:

• Identify major activities – Experienced Charge Management and Revenue Cycle teams know what they need to do and have learned from past years’ efforts. If new to this process, you can use recent H&A articles to identify activities, owners, and due dates for your workplan. Consider when essential data, references, and resources will become available as you assign preliminary dates for tasks.
• Work backwards – Consider your organization’s priority file update deadlines while aiming towards a January 1st ‘live’ date. The most reliable workplans are based on collaborative timelines developed by a project team. Proactive hospitals typically include representatives from Charge Management, Revenue Cycle, Hospital Information Systems, Patient Accounting, Coding/HIM, and other key personnel for the planning phase. Coordinating these key ‘support’ personnel will ensure there are no last minute surprises.
• Know possible contingencies – Proactive teams identify and integrate all priority milestones into their Annual Update work plan. However, multiple contingencies and alternative system updates may also need to be considered. Outlining these contingency items in your work plan will help keep your team coordinated and working collaboratively.
• Define dates for obtaining reference materials – Our recommendations for resources and reference information have been mentioned in previous articles. There are many reference points to consider for complete annual updates, so don’t underestimate the importance of integrated resource information. Never count on just a code book or masterfile alone. Coding guidelines, auditor/consultant notes, payment system details, and code change rationale are essential to a complete understanding of how charging systems may need to change.
• Start now – Most of our customers have begun preliminary annual update activities. By now, your team should have access to AMA 2018 CPT® code details either through your CDM vendor or as hard copy manuals. Preliminary review of this initial data should be included in your work plan for completion within the next two weeks to a month. And remember, year-end is the perfect time to have departments review CDM sections. Provide file exports and have each department flag charges for inactivation that are no longer valid or pertinent. Also be sure to correct invalid 4Q17 codes to ensure that your 2018 update routines are accurate.
• Expand your work plan beyond CPT® – CDM teams may have to remind departments that review of CPT® codes alone is insufficient for finalizing CDM changes. Include November or December work plan tasks for review of OPPS, I/OCE edits, and other payment system data as it becomes available (see more detail in the next section). Also, remember that departments are often unaware of data beyond one CPT® code section. Alternative code sections, Category III CPT codes, and HCPCS Level II codes are also key to compliant charge data. Some of this information will not be released for a few more weeks.
• Assign department tasks in phases – When assigning work plan tasks, remind departments that they will have several phases of file update work to do. As noted above, beyond CPT® code review, remember to set dates for departments to review payment system data and Final Rule changes that impact their CDM. This information will be released this month for various areas of Medicare reimbursement and integrated into CDM tools for a complete view of the 2018 changes. Plan to circle back to this complete information as your CDM Vendor integrates and releases additional reference data in November or December. Also, remember to plan for educational programs that are typically available in December. While much of the initial data review may have occurred, you can empower departments with a recap of changes based on a comprehensive, integrated view of the annual updates.
• Plan meetings for coaching, training, and education – Early December department coaching, refresher meetings, or personalized in-service educational sessions may be needed to bring departments up to speed. This can be in-house or supplemented by outside resources. Reference sheets for Status Indicators and Payment Indicators are helpful tools as well as any internal protocols related to CDM (charge description standards, billable supply policies, etc.). And finally, don’t forget that educational materials for each department must reflect your unique payment system. Be sure to use complete and accurately-focused resources.
• Offer quantitative information – Most departments appreciate a quantitative view of what they are facing with year-end changes. Identifying how many charges for a department are affected and more global information on changes to certain code sections will help determine time needed for annual updates.
• Vary the workplan by department – Flexibility is important when establishing timelines for each specific department. But once due dates for tasks are established, they need to be enforced. The volume and methods used for masterfile updates will determine the time to allocate. Ask your department representatives for firm commitments, but also allow reasonable time to perform thoughtful and complete review of changes. Remember that your departments are also balancing their clinical and technical department workloads and may be facing challenges with staffing and holiday schedules. Administrative support is essential for ensuring assigned tasks are completed on time.
• Stay on task – The Charge Management Team will need to monitor the annual update work plan progress carefully over the next eight weeks. Try to regroup weekly to ensure priority tasks are moving along. Unfortunately, in organizations without organized annual update programs, Charge Master updates are seldom a top priority. Now is the time to lead.

Summary

Remember that time is of the essence. Teams that develop a strong annual update work plan now will be more organized and coordinated.

CMS will soon be releasing several of their Final Rules and there will be much to consider. Whether you’re seasoned veterans or new owners of year-end updates, it’s vital that your team commits to a complete and thorough process to avoid future claims errors, lost payments, or misrepresented charges.

Other articles useful for creating a workplan:
Department CDM Update Internal Evaluation
Charge Master “Spring Cleaning” Tips
Annual Update Processes: The Charge Master & Beyond