Part of our new ChargeAssist “CDM Quick Tips” series We often see erroneous CDM content for intraocular lenses. This brief “CDM Quick Tips” reference document outlines CMS current IOL information. CMS has a specific website for New Technology Intraocular Lenses (NTIOLs) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/NTIOLs.html On the above website CMS notes “There are no CMS approved NTIOLS at this […]
Here are twelve tips to forging a partnership (or more than one partnership) to help your organization rapidly comply with soon-to-be effective rules.
We’ve witnessed providers and industry experts alike struggling for months to understand Medicare’s guidance throughout the COVID-19 Public Health Emergency (PHE).
on June 23, a federal judge upheld CMS regulations for January 2021 expanded price transparency requirements
Chargemaster Guide for the COVID-19 Public Health Emergency: Part 2 Laboratory Public Health Emergency CDM topics
Laboratory departments will need to stay vigilant for additional AMA and CMS updates for COVID test coding as well as other regulatory changes during the Public Health Emergency period.
Chargemaster Guide for the COVID-19 Public Health Emergency: Part 1 – COVID-19 PHE Background & Resources
Proactive monitoring of CMS and other payer coding and claims requirements is more essential now than ever to ensure correct charging, billing and payments.
H&A Comments on Hospital Price Transparency Final Rule Price transparency mandates will take on new and more extensive requirements based on a Final Rule published within the Federal Register on 11/16/19. Despite many comments from the industry regarding the rule’s implementation challenges and administrative burdens, CMS’ requirements remain closely aligned with the Proposed Rule and […]
Public Comments on Price Transparency were significant. Hospitals and health systems need to start planning now for expanded requirements from CMS.
Here is the H&A Comment Letter to CMS on expanded price transparency for 2020.
An Executive Order was recently issued stipulating expanded healthcare price and quality transparency mandates. Hospital leadership, Revenue Cycle, and CDM Teams must carefully monitor how these mandates unfold.
This blog post includes common challenges as well as the best five 'Insider Tips’ for a more proactive approach when selecting a new CDM tool.
Price Transparency “Round 2”– CMS Seeks Input The CMS “Pricing Transparency” may be taking a more significant turn based on a proposed rule from March 4, 2019. The topic of hospital prices has now been intertwined with potentially expanding rules on “information blocking”. This article shares a section of the language from a March 4th […]
This evaluation helps you assess where your facility is in the annual CDM Update process. Department CDM Update Internal Evaluation (Send to all Department Representatives involved in your annual CDM update process) Points Quality/Frequency (as applicable) 1 Bad 2 Poor 3 Fair 4 Good 5 Excellent 0 Not applicable Evaluation Questions ____ 1. Orientation […]
This article shares information on the current state of the industry, hospital needs, best practices, benefits of chargemaster software, and expectations for the future.
On January 1st, hospital and other healthcare provider claims annually fall under new coding and payment rules. We’ve compiled a checklist of several key tasks to help ensure complete implementation of the annual 1st quarter's CDM updates, and readiness for the other important, yet smaller quarterly updates.
The Chargemaster: What your Shopping Public Needs to Know Will the 2019 CMS chargemaster pricing transparency requirements confuse patients? …Most likely… Hospitals will likely vary in the details and scope of their patient communications relative to pricing transparency and Charge Master publication. We have provided ideas for how to communicate with your shopping public to […]
CDM Transparency – More speculation & More confusion (CDM Transparency Series) Late in the year, we find ourselves working with limited details and much industry concern about the CMS Charge Master publication requirements. Here at H&A, we’ve been collaborating with colleagues and clients alike to hear what hospitals are planning to meet the CDM Transparency […]
This post section includes Medicare’s original FAQ document on Price Transparency. (Further CMS FAQs are in the section that follows.) Frequently Asked Questions Regarding Requirements for Hospitals To Make Public a List of Their Standard Charges via the Internet Q. What format is a hospital required to use to make public a list of their […]
Q&A from CMS Leaves Hospital Questions Unanswered H&A CDM Transparency Series CMS has provided more clarification on the requirements for hospitals with the charge transparency mandate effective 1/1/19. Since the release of our 9/4/18 article, we have presented to an HFMA chapter meeting, and participated in numerous calls with customers and business colleagues to hear […]
IPPS CDM Public Access Announcement Causing Confusion & Concerns: Tips for Hospital Action Plans In this H&A CDM Pricing Transparency Series we focus on IPPS CDM Public Access Regulations focusing on tips for hospital action plans. The migration towards full pricing transparency is clearly underway and appears to be here to stay. We have included […]
IPPS CDM Public Access Announcement Causing Confusion & Concerns: Part 1 New Medicare Rules With minimal guidance in the IPPS Final Rule, hospital teams are wondering how they should address expanded Charge Master publication requirements regarding price transparency coming in January. Many have concerns about anti-competitive and public relations impacts. Others are more focused on […]
Succeed with Internal Pricing Analysis: Part 3. Avoid Pricing Analysis Pitfalls In Part 1 of our “Succeed with Internal Pricing Analysis” series, we outlined strategic planning tips to help your in-house pricing project run smoothly. Part 2 provided examples of analytical options. This is our final article of this series and addresses risks to avoid. […]
Succeed with Internal Pricing Analysis: Part 2. Fundamental Audit Protocols As budgets tighten and consulting investment is scrutinized, many health systems are internalizing pricing analyses and updates. Using ChargeAssist®, proactive customers analyze and monitor prices to: Support compliance with payer or state limitations on pricing updates Identify prices that have an extreme variance to […]
Succeed with Internal Pricing Analysis: Part 1. Have a Plan & Set Parameters “Succeed with Internal Pricing Analysis” Series Overview: In this three-part series, we will share strategic planning ideas, identify fundamental audit protocols to consider when defining your pricing analysis, and outline specific risks to avoid when performing internalized pricing studies. This article focuses […]
Charge Master “Spring Cleaning” Tips Now that the 1st quarter of 2018 is behind us, it’s time to revisit your organization’s Charge Management priorities. Here are seven easy “Spring Cleaning” tips that result in dramatic, strategic improvements. I. Identify Charge Management Priority Issues All Charge Master Teams tell us they face a constant barrage […]
Charge Master Implant Issues: Revisiting Definitions In 2014 we summarized various definitions of implants and the challenges for data accuracy within the Charge Master file. As time has passed, we have found that this topic continues to be challenging for hospital Revenue Cycle and Charge Master Teams. This is an updated article from our July […]
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, […]
Annual Update Processes: The Charge Master and Beyond – First Steps (Part 1) It’s ‘that time of year’ – Time to review coding, payment system, and annual regulatory update rules that will be effective January 1, 2018. Here’s part 1 of a two-part excerpt from our 2018 CDM Update Educational Program to help with your […]
CDM Management Strategies: Improving Charge Descriptions Part 1 – Charge Description Risks, Influences, & Improvement Strategies Does your hospital have a clear and definitive policy for charge descriptions? Hospitals and health systems are often challenged by how they should address billing descriptions. Updates are often low priority despite their importance. Let’s talk about the challenges […]
Feeling Targeted by Audits? Here’s one that can actually help… Many CDM Teams are unaware of the scope and implications of CERT audits. Mary Madsen, Senior Manager of Holliday & Associates has summarized the background and potential impact of the CERT program for our customers within this blog post. Read on to learn how CERT […]
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 […]
10 Steps for Failsafe Charge Data Management Busy Revenue Cycle Teams often overlook the basic steps of charge data management. This blog post includes ten proven steps that are pivotal to keeping charge data management a key operational priority. #1 Define Charge-Oriented Data Flow & Processes Charge data and Charge Master management processes are complex […]
Charge Management Assessment Periodic assessments help health systems evaluate their charge and CDM Management processes, and refine their organizations’ unique priorities. The assessment that follows can be performed prior to and periodically following process improvement work to quantify charge management success. Charge Management teams can apply common risk management concepts for assessing their organizational charge […]
Quantifying CDM Audit Results CFOs often ask their teams about return on investment projections before investing in new Charge Master software or projects. Similarly, compliance staff may worry about exposure when charge data errors have been uncovered. Beyond the operational efficiencies of Charge Master software and consulting, there are often measurable results that must be […]
Self-Administered Drugs: Charge Master Compliance Checklist Does your hospital have adequate controls for addressing Medicare’s self-administered drug coverage restrictions? We have developed a Charge Management Compliance checklist to help our customers with this challenging area. When tackling Self-Administered drug billing compliance (also referred to as “self-administrable drugs” or “SADs”), many hospitals are amazed at the […]
HIS Implementation: Charge Data Mistakes & Safeguards More and more hospitals are planning, in-process, or regrouping from Hospital Information System (HIS) conversions. Surprisingly, we are noting a growing trend of inaccurate Charge Master (CDM) data left in the wake. This article highlights frequently-encountered systems implementation mistakes that may be placing your charge data integrity at […]
Hospital Prices in the News: 10 Tips Poor communication on pricing can undermine patient loyalty and community support. The recent Modern Healthcare article “Stricter Chargemaster Regulations Needed to Rein in Healthcare Pricing” may have already caused ripples in the boardroom. It’s important to know what the press is saying, and communicate proactively about your pricing […]
July Coding Changes: Pathogen Reduced Platelet Products &Testing Introduction CMS has released two new HCPCS Q codes for pathogen reduced platelet products and associated pathogen testing. The new codes are effective July 1, 2017. Charge Master or Revenue Cycle teams should review this new regulatory guidance with owners of applicable transfusion medicine, blood bank or […]