Welcome to the sixth article in our 10-week series on demystifying the chargemaster. In this installment, we delve into the recommended frequency for updating the chargemaster. Finding the right balance between regular updates and operational efficiency is crucial to maintaining an accurate and up to date chargemaster that aligns with coding guidelines, regulatory requirements, and pricing transparency. Understanding the factors that influence the frequency of updates will help healthcare organizations establish an effective update schedule.
Finding the Right Balance: Recommended Frequency for Chargemaster Updates
- Regulatory and Coding Guideline Changes: Regulatory guidelines and coding practices are subject to frequent updates (at least quarterly). It is essential to stay current with changes in regulations, such as Medicare and Medicaid guidelines, as well as coding guidelines such as American Medical Association (AMA) CPT codes. Regular updates should be conducted to evaluate any associated National Correct Coding Initiative (NCCI) code pair edits and Medically Unlikely Edit (MUE) maximum units of service to ensure accurate billing and coding compliance after implementation of changes.
- New Services and Procedures: Healthcare organizations frequently introduce new services, procedures, medications, and supplies on the basis of newly released products and technology. It is crucial to promptly incorporate these additions into the chargemaster to ensure accurate representation and billing of these items. Regular updates allow for the inclusion of new services and procedures, facilitating accurate coding, appropriate pricing, and optimal reimbursement.
- Pricing Updates: Pricing within the chargemaster should be reviewed at least annually to reflect changes in costs, market dynamics (including peer price transparency), and reimbursement rates. Pricing updates can be influenced by factors such as inflation, changes in the cost of supplies or medications, negotiated contracts with payers, and fee schedule changes. Regular reviews and adjustments help maintain pricing transparency and ensure fair reimbursement.
- Seasonal or Annual Updates: Certain services or procedures may have seasonal or annual variations. For example, flu shots, vaccinations, FDA approved products or technology, or specific diagnostic tests (e.g., proprietary laboratory analyses) may be offered during specific times of the year. It is important to update the chargemaster accordingly to capture these variations and reflect accurate pricing and coding during specific periods.
- Internal Process Changes: Changes in internal processes, such as department restructuring or consolidation, may necessitate updates to the chargemaster. These changes can impact coding assignments, revenue codes, mapping to ancillary systems, and overall charge capture workflows. Regular reviews and updates help ensure that the chargemaster accurately reflects these process changes to maintain operational efficiency.
- External Audits and Reviews: Look outside your organization every 2-3 years to have a full review of the chargemaster by industry experts. External audits or reviews, such as those conducted by chargemaster vendors, may uncover discrepancies or non-compliance within the chargemaster. In such cases, immediate updates should be made to rectify any identified issues. Key staff members can learn how to perform more effective periodic internal audits to help identify areas of improvement and trigger necessary updates to enhance chargemaster accuracy and compliance.
Balancing the need for regular updates with operational efficiency is essential. While there is no one-size-fits-all frequency for chargemaster updates, healthcare organizations should strive for a balance that allows for timely incorporation of changes without creating an excessive administrative burden.
Collaboration among the chargemaster coordinator, coding professionals, clinical departments, charge capture specialists, and the finance team is crucial in determining the optimal update frequency. Regular communication and ongoing monitoring of industry changes and internal processes will help establish a suitable schedule that ensures an accurate and compliant chargemaster.
By adhering to the recommended frequency for chargemaster updates, healthcare organizations can maintain coding accuracy, optimize reimbursement, support pricing transparency, and mitigate compliance risks, ultimately enhancing revenue cycle management and operational effectiveness.
Join us in the next installment of our series, next Friday, as we explore the importance of utilizing technology and automation in chargemaster management, and how it can streamline processes and improve efficiency.
If you want to self-learn, check out our sister brand, RACmonitor’s educational webcast “Managing a Compliant Chargemaster – The Backbone of your Revenue.” This 30-minute webcast provides authoritative guidance on managing and defining data in your CDM. Get it for $99 by adding it to your cart here: https://racmonitor.medlearn.com/product/managing-a-compliant-chargemaster-the-backbone-of-your-revenue/.