Chargemaster Reviews Promote Outpatient Revenue Integrity

Seven outpatient account issues to know

In Pena4’s recent article “Chargemaster Reviews Promote Outpatient Revenue Integrity” published in HFMA’s Revenue Cycle Strategist I was asked to respond to the following question: 

We are experiencing increased denials and loss of revenue due to chargemaster issues related to outpatient services coding. What steps can we take to identify the issues and clean up the chargemaster?

This blog summarizes my response regarding outpatient account issues and strategies to promote outpatient revenue integrity.

First of all, the rise in outpatient services provided at various outpatient locations adds to the complexity of revenue integrity challenges. Proper outpatient coding, documentation and charging are critical to reduce and prevent denials—and ensure accurate reporting and reimbursement. Here are seven outpatient account issues to know:

  • Coding errors and documentation gaps, including missing CPT codes and ability to show medical necessity
  • Hard-coded codes, assigned by the chargemaster that are not visible or available during soft coding
  • Inadequate or missing charge-validation processes
  • Outdated or invalid chargemaster
  • Lack of process to assign correct and applicable modifiers
  • Timeliness of charge entry
  • Absence of internal charge reconciliation process within ancillary departments

The list may seem daunting, but the best way to identify and address specific issues is to begin with a review of your chargemaster.

Chargemaster review and maintenance avoids denials

Denial management requires a thorough chargemaster review to understand root causes of denials, followed by ongoing maintenance to avoid potential issues. Ensuring accurate CPT/HCPCS codes is the main concern in a chargemaster review. Checking for new, revised and deleted codes is critical to proper reimbursement.  As an integral part of chargemaster review and maintenance, here are three strategies to help ensure chargemaster integrity.

Conduct onsite interviews with individuals from each department. Review processes, assess workflows, identify issues and explore solutions.

Create a charge capture reconciliation process. Using a report of all cases completed the previous day, assign someone in each department to review all charges.

Establish best practices to proactively identify issues. Maintain the chargemaster routinely, develop a reimbursement integrity program and appoint a chargemaster coordinator and team to oversee the maintenance process. 

Chargemaster review and maintenance will help eliminate denials by ensuring all codes, supplies and revenue codes are up to date and accurate. Rigorous oversight of chargemaster integrity promotes revenue integrity.