The advent of Medicare's ambulatory patient classifications, or APCs, has riveted attention on the chargemaster, that daunting price list of goods and services every hospital maintains.
Until the current cost-based system, the codes assigned to each item in the chargemaster didn't matter much when it came to Medicare reimbursement. Often, hospitals assigned codes that didn't accurately reflect the goods or services involved.
"There was no financial incentive to get it right," says Peggy Wolf, a director at 3M Health Information Systems Consulting Services in Atlanta.
Precise coding will become critical July 1, when APCs take effect for outpatient billing. With APCs, reimbursement will be tied directly to specific Current Procedural Terminology codes.
Wolf and two other presenters from 3M, senior manager Susan Garrison and ambulatory-product manager David Fee, will explain how to update coding to maximize reimbursement and avoid compliance problems in their session, "Getting Chargemaster Up for APC," on Wednesday, June 28, from 8 a.m. to 11: 30 a.m.
Maintaining the chargemaster, which can contain 6,000 to 50,000 line items, requires at least an annual review to keep up with new codes, Wolf says. Also, service changes and new equipment can require coding amendments, Wolf says.
The trio will discuss changes in infrastructure for maintaining the chargemaster, including the importance of assigning a single coordinator. They'll also discuss the importance of involving department managers, finance staff, billing staff and health information managers in the process.
The average hospital "doesn't have a real good process in place for maintaining the chargemaster," Wolf says.
Mike Kovar, a principal in the healthcare advisory service practice at KPMG in Baltimore, will also take a stab at the chargemaster, but from a legal angle. His session, titled "Chargemaster Compliance," is set for Monday, June 26, from 10: 30 a.m. to 12: 30 p.m.
Kovar will identify pitfalls such as incorrect codes that could lead to overbilling, subjecting a hospital to financial penalties and the potential for a wide-ranging fraud probe.
While the emphasis will be on compliance, Kovar will also address the potential for boosting revenue under APCs by identifying new line items.
Kovar says he'll gear his talk to both middle managers and executives such as chief executive officers and chief financial officers. "The responsibility for accurate billing resides ultimately with the hospital's CFO or CEO, depending on how you look at," he says.