Real World Case Reimbursement rules require that the chargemaster drives a facil
ID: 428772 • Letter: R
Question
Real World Case
Reimbursement rules require that the chargemaster drives a facility’s charges. To receive the optimal reimbursement for services rendered, the chargemaster must be up-to-date and all-inclusive and must meet any payer rules and regulations.
The UMUC facility has decided to undergo a review of its chargemaster to ensure that it meets the above criteria. In addition to the comprehensive evaluation, one of the other objectives of the project will be to institute the procedures to ensure that all additions, revisions, and deletions meet the chargemaster standards. In a minimum of 250 words, respond to questions below. Once your material is posted, be sure to review and comment on at least two of your peers postings. Your initial post to the given topic of discussion should contain a minimum of 2–3 peer-reviewed references.
How could the facility measure the success of the chargemaster review project?
Which facility departments should be included on the project team? Describe the role and responsibilities of each team member?
Who would be the most appropriate project sponsor? Who are the project stakeholders?
Explanation / Answer
A hospital charge master plays the most crucial part in determining the transactions of the hospital and maintaining the cash success. The hospital charge master needs to keep the codes updated so that the claims of the patients can be effectively paid. A charge master review must be done effectively in 2 years.
With the help of facilities, fully compliant coding data can be updated on a regular basis in the charge master, thus facilitating the process of claim processing and payments. In the absence of facilities, the claims cannot be validated successfully and so cash processing will get affected. Compliance adherence is also facilitated with the inclusion of facilities in the processing of the charge master review project. Generally the revenue department is included in the project team. The revenue department is usually proficient with the reimbursement rules and so, their inclusion facilitates the process of claim processing. Administration department may also get included in the project team, as their awareness will help in process adherence.
The most appropriate project sponsors for this charge master review project would be the hospital or the medical system. This is so because the hospital is the primary stakeholder in this project. Other major stakeholders of this project are the patients and the various forms of health care providers like medical centers, insurers, managed care providers, etc.
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.