You are the assistant director of the HIM department. You have just been given t

Question

You are the assistant director of the HIM department. You have just been given the responsibility of maintaining the chargemaster. The person who was maintaining the chargemaster just quit, and to save money, administration has decided to add this to your current duties instead of filling the position. You only spent a day with the person who resigned to learn about what you need to do.

This is what you learned:

• The chargemaster coordinator did 100% of the maintenance on the chargemaster.

• If she had a question, she would call and ask the appropriate department.

• She was about 3 months behind in her maintenance.

• When departments started new services, she usually learned about them a week after they started, when billing problems arose.

• The reason that she quit was because she was so frustrated with her job.

You are concerned about what you have gotten yourself into. You know that you cannot do this alone, especially on top of your other duties, which were not decreased when this responsibility was added. You drag out your old textbooks, surf the Internet, and order a new book on chargemaster maintenance. After studying up on the subject, you decide to draft a proposal on a better way to manage the chargemaster. You want to do a good job because the director has agreed to send the final report to administration.

What plan would you come up with?

Explanation / Answer

Chargemaster in HIM ( Health information management) department is the set of charges used in hospital billings. The charge master setup determine how the charges appear on the claims and patient records.

The main components of a charge master would be charge number, description, revenue code, rates or price.

There are several tasks for chargemaster coordinators like identifying new codes, meeting clinical users to provide education, track reimbursements, ensures revenue accuracy.

There are two main concern areas -

3 months behind maintenance and learning about new services a week later.

To solve this problem, the first thing that should be done is streamlining of processes.

rather than the charge master coordinator calling up the appropriate departments, the departments should themselves call the coordinator and inform about the changes.

This will ensure that the chargemaster is properly maintained for any new services introduced.

Tasks should be categorised for periodic updates like service line changes should be updated daily, medicaid regulations should be updated quarterly and medicare rules and pricing should be updated annually.

Proper plan should be made by meeting different department leaders. Training plan should be defined for the end users for the changes implemented. Audit strategy should be defined and necessary codes should only be kept. The IT infrastructure should also be reviewed to incorporate the necessary changes. All line items should be reported with proper CPT/HPCS code.

The overall Record Keeping should be centralised to ensure coherence. IT infrastructure should be used to ensure automatic updation of records. price changes should be validated against pricing model.

Charge records, charge capture tools, orders and prices should be smoothened using Information technology softwares. This will reduce errors and make implementation of changes much easier.

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