As we move into the era of data quality and value-based reimbursement in healthcare, the concept of data in – data out has never been more important. Today's industry environment calls for strict adherence with coding and billing guidelines to allow you to submit claims with confidence. Gone are the days of focusing on Medicare claims compliance while bypassing the claims editor for all other payors. Knowing that the chargemaster is complete for all procedures, services, items, and drugs helps to ensure charge capture. However, it simply is not enough to say the chargemaster is complete for each revenue-generating department – complete and compliant systems with consistency across all entities within the health system should be the goal.
When managing the charge capture processes for multiple hospitals, clinics and providers this goal may seem unattainable. With systems for chargemaster maintenance requiring multiple people to complete multiple touch points just to add, delete, or revise even a single line item, how do you devise a comprehensive yet efficient workflow to consolidate and synchronize multiple chargemasters across an entire enterprise?
Some chargemaster systems boast of the ability to track and compare line items across an organization and to compare line items to a corporate standard. However, this process does not lessen the need for knowledgeable personnel to review and translate line item descriptions and validate CPT, revenue category codes, and modifiers. Whether utilizing a manual workflow process or relying on a workflow embedded within the chargemaster management software, multiple touch points continue to exist. This method continues to consume staff time, risk of error still remains, and the timeline for completion of a corporate synchronization for the entire enterprise is impacted by staff schedules and priorities and often is postponed for a later date or only partially implemented.
The reality is that today we are operating in an age of mergers and acquisitions in which no health system remains stagnant – and with each addition of service or change in provider (much less the addition of an entire hospital to the revenue cycle), chargemaster synchronization is an ongoing process that requires efficiency and accuracy in order to maintain revenue capture while ensuring compliant billing and accuracy of reimbursement. Achieving and maintaining chargemaster synchronization is vital to ensure consistent data quality across entities within a health system. It is critical for the integrity of decision support systems and reporting which management relies on for decision-making.
Leveraging Panacea's in-depth knowledge of healthcare and revenue cycle management, our team has worked diligently to enhance the industry's only software solution dedicated to the synchronization of disparate chargemasters. Placing the power of a standalone tool like CDMsync™ at the fingertips of chargemaster coordinators and/or your revenue cycle management team will allow the process to be orchestrated with significantly improved efficiency and accuracy. Those hospitals not having the internal resources can utilize Panacea consultants to assist.
CDMsync™ is a component of Panacea's comprehensive CDMauditor.com suite of software. Its capabilities include synchronizing disparate CDM service codes, patient care service descriptions, HCPCS or CPT codes, revenue codes, and prices. The system utilizes a proprietary matching algorithm that matches similar services offered across multiple entities by reading all relevant variables available in the disparate chargemasters resulting in a standardized or corporate CDM. Because the system does not rely on an external standard for correlation of line items, it also provides the flexibility necessary to allow your chargemaster to be established as the standard for synchronization of order entry modules. Those health systems having standardized CDM service codes and descriptions however due to decentralization of responsibilities have inconsistent revenue, modifier or hcpcs code and pricing can leverage CDMsync to flag all inconsistencies. Moreover, CDM sync will help to identify the most predominantly utilized codes across entities.
A typical engagement for CDMsync™ involves uploading CDM and usage files and establishing standard Panacea Clinical Groups (PCGs) for aggregation of like services, after which the system will proceed to match items or group seemingly like items. From there, a Panacea consultant or someone on your team will utilize an innovative drag-and-drop feature to finalize and create a master CDM across the health system's entities. The same efficient technology and steps allow for the matching of order entry to the chargemaster.
Once the process is complete, clients can expect upward of 80-90 percent synchronization rates, with the balance being services not offered at all entities or representing disparate billing practices across the system (i.e OR time, hard-coded modifiers versus soft-coded modifiers, etc.). CDMsync produces a percentage of match completion report by PCG, as well as an unmatched report by service code line item, with customized comments provided for each and every unmatched item by our consulting team. This facilitates the decision-making process governing whether to standardize billing practices or to accept the disparities after further consideration. Furthermore, CDMsync will produce a normalization report that identifies for every matched set of services where differences exist in coding, pricing, or service descriptions for ease of standardization.
Over the past three years Panacea consultants have had great success using CDMsync for several health systems undergoing system conversions, after a period of acquisitions, allowing for the creation of a corporate standard CDM based on industry best practices. Due to the state-of-the-art technology and consulting expertise all of these engagements have been completed in five months or less with very little burden on the client. This process also has led to standardization for purposes of financial and statistical reporting and productivity benchmarking and identification of inconsistencies between the CDM and the order entry system, which ensures a more reliable and defensible charge capture process. Recent engagements were completed in less than four months.
Now is the time to leverage technology and talent to establish and maintain your organizations chargemaster standardization and synchronization.
For more information on CDMsync™ or Panacea's other chargemaster services, contact John Anderson at 800-252-1578, Ext. 3425, or register here.