From coding to compliance, a hospital’s revenue cycle and financial success depends on charge description master accuracy and completeness. Increased scrutiny on price transparency and the rapid pace of regulatory and code updates requires a modern chargemaster strategy and consistent, recurring chargemaster maintenance.
Our chargemaster management solutions help promote revenue integrity through a wide assortment of features that improve efficiency and productivity while eliminating the costly issues that lead to billing rejections and denials.
How we elevate hospital chargemaster integrity
Increase productivity with automated CDM analysis
- Its auto-analysis functionality thoroughly scans and identifies potential coding and billing edits for all services, pharmacy and supply charge lines. Our solution makes it easy to create approval and reporting processes to track and manage change history.
- In multi-hospital system situations, the analysis compares local and/or regional CDMs to the corporate standard to ensure alignment.
Reduce compliance risk with proprietary content
Reduce compliance issues with coding or within the chargemaster with our searchable Uniform Billing Editor e-book (Ultimate Guide to Facility Claims Submission). . More | + |
- A go-to resource for coders and chargemaster coordinators, this proprietary documentation addresses problems that are core to hospital revenue cycle processes. It includes a CPT®/HCPCS to revenue code crosswalk, Medicare coding and billing tips (APCs, IPPS, OPPS, etc.) and more. This is just one example of the content provided within RevenueCyclePro.com.
- Dive deeper into complex regulatory compliance topics with RevenueCyclePro.com and California Medicaid Add-ons. Browse Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) edits, Medically Unlikely Edits (MUEs), national and local coverage determination (NCD and LCD) policies for medical necessity, national drug codes (NDCs) and California Medicaid (Medi-Cal) edits.
- Reduce potential coding denials with access to the latest coding details from RevenueCyclePro.com (future new, revised and deleted with suggested replacement codes). Use this information and other resources, including clinical documentation guidelines, to help develop staff education pertinent to clinical and coding staff. EncoderPro.com offers compliance-related coding resources for health systems managing physician practices and clinics.
Build strategic pricing models with supportive data
Provided as part of the Outpatient Margin Report (Peer Pricing) Add-on, this data is in an easy-to-implement format and allows comparisons of Medicare, CBSA and peer pricing. More | + |
- Access pricing analysis with data from the Outpatient Standard Analytical file (OPSAF) published by the Centers for Medicaid & Medicare Services (CMS).
- Improve revenue capture by facilitating accurate and competitive pricing, and ensure prices are validated against current APC rates - the first steps in setting defensible pricing, using RevenueCyclePro.com. Our APC calculator helps you validate and manage outpatient APC and composite APC reimbursement under Medicare, identify and resolve underpayments, and determine the patient’s copayment amount.
- Analyze DRG payment rates and ensure accuracy with the RevenueCyclePro.com DRG calculator, which uses hospital-specific DRG calculations for each DRG, based on the operating and capital values in effect for each provider number.
- Access drug payment and average wholesale pricing (AWP) data in DrugReimbursement.com. Current AWP package pricing, Medicare Part B ASP and hospital APC/OPPS drug pricing information help you monitor drug charges, costs and expected Medicare reimbursement. Get additional guidance and suggestions on CDM strategic pricing policies and price transparency ruling compliance through Optum Advisory Services.
Boost data quality with a proprietary coding and billing reference library
Access more than 30 years of medical coding industry experience with web-based tools (RevenueCyclePro.com, EncoderPro.com or DrugReimbursement.com) to manage critical coding, billing and reimbursement elements within a hospital’s chargemaster and revenue cycle. More | + |
- Optum360 chargemaster management solutions provide the guidance required to help your organization stay current and compliant.
- CPT®, HCPCS, ICD-10 and DRG coding changes and edits are delivered to the application frequently, providing access to the latest coding information. This allows you to refresh your CDM with new, revised and deleted codes quickly. Optum360 proprietary content improves productivity and data quality by helping you confirm that procedure, drug, item and diagnosis codes and related modifiers submitted on claims are valid, accurately assigned and appropriately linked.
- RevenueCyclePro.com also provides access to our top-selling Optum360 DRG products, DRG Expert and DRG Desk Reference. These comprehensive tools provide detail regarding reimbursement, crosswalks, MS-DRG assignment and more. Optum360 proprietary Post-acute Care Library and Clinical Documentation Guidelines content is also accessible.
- Ensure chargemaster supply and pharmacy charge lines are complete and valid using our proprietary supply and pharmacy modules. Researching proper coding and billing elements for new drugs and supplies is labor intensive — our Supply Item Master and Pharmacy Formulary allow you to review thousands of supply and pharmacy charge lines with one click. We provide critical insights into whether a supply item is separately reportable or is considered routine per CMS guidance, along with its associated HCPCS, if applicable. This includes flags for incorrect or inappropriately assigned HCPCS, charge lines for supplies not separately billable, charge lines missing for items that are billable, as well as a review of pharmaceutical bill units and appropriate NDC.
Tools to boost chargemaster accuracy and completeness
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Denied and rejected claims
and bad debit write-off can be 3.3% of a provider's net revenue2
Financial challenges are the No.1 concern for hospital CEOs1
Avoid the chargermaster being the root of revenue integrity issues.
$118 per claim2
Average cost for providers to rework each denial
Explore these helpful chargemaster resources
Download an easy to print version of this page.
These short YouTube videos highlight common questions when updating chargemaster files.
Our latest white paper details successful steps chargemaster maintenance and offers a suggested action plan.
This white paper details the CMS price transparency regulation and offers price setting tips.
Join this session to learn how Enterprise ChargemasterExpert.com will assist in implementing and maintaining a complete and accurate chargemaster.
See how a community hospital center leverages Optum360 Enterprise ChargemasterExpert.com
CPT is a registered trademark of the American Medical Association.
- Chess, Eva. “Survey: Healthcare Finance, Governmental Mandates, Personnel Shortages Cited by CEOs as Top Issues Confronting Hospitals in 2018”, American College for Healthcare Executives, 25 January 2019. Press Release.
- Hallock, John. “Change Healthcare Analysis: An Estimated $262 Billion in Healthcare Claims Initially Denied in 2016,” Change Healthcare Healthy Hospital Revenue Cycle Index, 26 June 2017. Web.