You are a financial analyst that is part of a chargemaster maintenance team. In the absence of the previous chargemaster coordinator, you are now responsible for chargemaster audits and maintenance process. You discover that chargemaster maintenance is three months behind. You quickly determine that you will not be able to complete chargemaster tasks in addition to your other job responsibilities. After reviewing research and literature on best practices for chargemaster management (i.e. updating codes, automation, audits, set charges, etc.), you decide to create a process for chargemaster maintenance. Present your findings and process in a proposal to the maintenance team.
Assignment Instructions
For this assignment, you are to:
Examine the selection and development of applications and processes for chargemaster and claims management.
Compare examples that emphasize the methods for controlling cost by reducing errors.
In a written proposal:
- Explain/ summarize the importance of claims management and chargemaster maintenance.
- a. Identify at least three best practices. b. Describe why they should be included in your chargemaster maintenance process.
- Create a process for chargemaster maintenance.
Provide a visual/graphic display of your process.
Describe each step and/or component of the process.
Full Answer Section
Here are three best practices for chargemaster maintenance:
- Regularly review and update the chargemaster. This includes adding new services and items, deleting obsolete services and items, and updating prices.
- Audit the chargemaster regularly to identify and correct errors. This can be done manually or with the help of automated software.
- Develop and implement a process for managing change requests. This process should ensure that all change requests are reviewed and approved by the appropriate personnel.
Chargemaster Maintenance Process
Here is a proposed process for chargemaster maintenance:
- Identify and prioritize change requests. This can be done by collecting change requests from staff, reviewing payer updates, and monitoring industry trends.
- Review and approve change requests. This should be done by a team of knowledgeable individuals, such as clinicians, coders, and billing staff.
- Implement the approved change requests. This may involve updating the chargemaster database, updating system configurations, and training staff on the new changes.
- Test the changes. This is important to ensure that the changes have been implemented correctly and that they are working as intended.
- Monitor the changes. Once the changes have been implemented, it is important to monitor them for any unintended consequences.
Visual/Graphic Display of the Chargemaster Maintenance Process
The following diagram shows a visual representation of the chargemaster maintenance process:
[Diagram of chargemaster maintenance process]
Description of Steps and Components
The following is a description of each step and component of the chargemaster maintenance process:
- Identify and prioritize change requests: This step involves collecting change requests from staff, reviewing payer updates, and monitoring industry trends. Change requests can come from a variety of sources, such as clinicians, coders, billing staff, and patients. Once the change requests have been collected, they should be prioritized based on their importance and urgency.
- Review and approve change requests: Once the change requests have been prioritized, they should be reviewed and approved by a team of knowledgeable individuals, such as clinicians, coders, and billing staff. The review process should ensure that the change requests are accurate, necessary, and compliant with payer regulations.
- Implement the approved change requests: Once the change requests have been approved, they should be implemented in the chargemaster database. This may also involve updating system configurations and training staff on the new changes.
- Test the changes: Once the changes have been implemented, it is important to test them to ensure that they have been implemented correctly and that they are working as intended. This can be done by generating sample bills and claims.
- Monitor the changes: Once the changes have been implemented and tested, it is important to monitor them for any unintended consequences. This can be done by reviewing billing and claims data, as well as feedback from staff and patients.
Conclusion
Claims management and chargemaster maintenance are two essential processes for healthcare organizations. By following the best practices and process outlined above, healthcare organizations can improve revenue collection, reduce denials and rejections, ensure compliance with payer regulations, and improve patient satisfaction.
Sample Answer
Chargemaster and Claims Management
Claims management and chargemaster maintenance are two essential processes for healthcare organizations. Claims management is the process of submitting and tracking claims to payers. Chargemaster maintenance is the process of ensuring that the chargemaster is accurate and up-to-date.
The chargemaster is a database of all the services and items that a healthcare organization provides, along with the associated prices. It is used to generate bills for patients and to submit claims to payers.
Claims management and chargemaster maintenance are important because they help healthcare organizations to:
- Improve revenue collection
- Reduce denials and rejections
- Ensure compliance with payer regulations
- Improve patient satisfaction
Best Practices for Chargemaster Maintenance