HIS Implementation: Charge Data Mistakes & Safeguards
HIS Implementation: Charge Data Mistakes & Safeguards
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 work flow processes are created for charge capture and Charge Description Master 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 are populated redundantly leaving more data to maintain in the future (for example, multiple HCPCS or modifier fields)
- Staff are not clear 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 (Charge Master, pharmacy system, etc.) may contain errors that slip past ‘high level’ automated file analysis
All of the previously-noted implementation mistakes carry significant risk to a health care system’s charge data integrity, and can undermine years of strong Charge Master 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 Charge Master 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 are constantly changing. Because of this, remediation of potential charge data risk needs to always be priority. The following actions can ultimately safeguard charge data for assured compliance and revenue integrity before, during, or following an information systems installation project.
- 1. Give Charge Management and key Revenue Cycle team members the opportunity to participate in work flow 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.
- 2. 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 Charge Master Team should be aware of the overall systems landscape to serve as appropriate stewards for long-term charge data integrity.
- 3. 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 Charge Master advisors can ensure the correlating charge data is compliant. Our customers can use the ChargeAssist® 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.
- 4. 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, and new claims editing rules that will modify charge data.
- 5. 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 charge master 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.
- 6. Create charge data flow charts, schematics, and documentation of systems functionality and distribute to all staff impacted by the changes (including Rev Cycle and CDM Team). 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.
- 7. 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.
- 8. 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.
- 9. 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, charge master 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.
- 10. 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 Charge Master auditing tool will support data monitoring, eliminate subjectivity, and make auditing and monitoring simple. A coordinated process with new Charge Master 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, mid-way through, or just 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 create significant operational disruption despite proactive planning and ample staffing. We encourage our Revenue Cycle and Charge Master 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 Charge Master 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. If your leadership team would like to discuss the concepts included within this article, please feel free to contact the author at email@example.com.
Exhibit 1 – Who are the key HIS players?
In today’s ever-changing landscape of hospital information systems vendors, it helps to know the primary vendors and understand how various companies have risen (and fallen) over the past decades. Vince Ciotti and Elise Ames of HIS Professionals, LLC reported on the “Top 10 HIS Vendors by 2016 Revenue” in a slideshow used within their “HIStalk: Healthcare IT news and opinion”. The company has been tracking vendor revenue trends for nearly 20 years. Based on 2016 reported annual revenue, the top two vendors for 2016 were Cerner and Epic. Allscripts and McKesson were relatively close in third and fourth positions with athenahealth in the fifth position. However, mergers and acquisitions during the past few years have impacted revenue trends rather significantly for several vendors. For further information on various vendors in the electronic medical record market-space, click here for Becker’s Hospital Review article.
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.
Visit Holliday & Associates web page for details on software functions and consulting services here: https://www.chargeassist.com/chargeassist/
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