AAHAM WESTERN REGION CHAPTER Presenter: Rosemary Holliday - PowerPoint PPT Presentation

CHAR CHARGE GE MASTER MASTER ISSUES & PRIORITIES ISSUES & PRIORITIES AAHAM WESTERN REGION CHAPTER Presenter: Rosemary Holliday May 2013

Agenda 2  Hot Topics  2013 CDM Update Highlights  Charge Management Processes  Today’s Charge Master Challenges

Hospital Pricing in the Spotlight 3  Recent News:  “Bitter Pill” and “Killer Apps”  Medicare Provider Charge Data  Pricing in the Press

Strategies 4 Take the offensive Identify basis for 1. 4. pricing Ensure defensible 2. charge data Realistic Perspective 5. Develop a plan Pricing image ‘self - 6. 3. check ’

Hospital Pricing in the Spotlight 5 Pubic Relations Processes Data

Revisiting 1Q2013 Updates 6 What happened?  Why was it challenging?  What was the outcome? 

Revisiting 1Q2013 Updates 7  What Happened?  CPT & HCPCS code changes  CMS payment system updates  Implementation by payers & providers  Operational and reimbursement impact

Revisiting 1Q2013 Updates 8  Why was it Challenging?  Quantity and type of updates  Timelines  New charge structures & repricing  New documentation and charge capture  Limited payer guidance

Revisiting 1Q2013 Updates 9  What was the outcome?  Weak CDM processes exposed  Collaborative relationships strained  Department engagement taxed  ‘Stars’ &‘black holes’

2013 CDM Updates 10 Top 10 Areas of Impact

Psychiatry 11  Psychiatric diagnostic evaluation  Psychotherapy  Crisis psychotherapy  Add on codes

Rehab Services 12  Caps  Threshold  MPPR  Functional Reporting  CMS Claims Edits

Cardiovascular System 13  Vascular Injection Procedures  Therapeutic Services  EP  Charge & Code Capture  Coding Resources

Diagnostic Imaging 14  Bundling Continues  Diagnostic Imaging  Nuclear Medicine  Radiology Modules

Pathology & Laboratory 15  Code updates  Miscellaneous Code updates  Molecular Pathology  Regulatory Updates  CA Laws  H.I.S. Integration

Neurology 16  Coding Updates  Neurostim electrode array implantation  Chemodenervation  Nerve Conduction Tests  Intraoperative Neurophysiology  Autonomic Function Tests  Motion Analysis  Motor Function Mapping  Vagus Nerve Blocking Therapy

Pharmacy 17  Code Updates  CMS & Other Payer Req’mts  H.I.S. Functionality  Pricing

RT / Pulmonary Medicine 18  New Guidelines & Instructions  Code revisions  Sleep Medicine - peds  OPPS Updates  Long-standing issues

Ophthalmology 19  New & Established Definition  Other Code Updates  MPPR

E&M Codes 20  Visit Codes – Trends & Politics  C4 & TCM Services  Pediatric Critical Care Patient Transport Supervision  OPPS Guidance & Payments

Other updates 21  Other CPT Changes  HCPCS Level II Codes  OPPS Pass Through Devices  Non-Medicare Codes

Remaining 2013 Priorities 22  Day-to-day charge management  Quarterly updates  Audits  Hospital projects & initiatives  2014 planning

Charge Management 23

Defining “Charge Management” 24 “Oversight and control of all aspects of charge data throughout the organization”

Assessing Charge Management 25  What’s our approach?  Reactive?  Proactive?  Somewhere in-between? Proactive Reactive

Assessing Charge Management 26  Quantify charge data quality  Quick Assessments  Indicators of accuracy  Third party feedback  Are assumptions correct?

Evaluation Techniques 27  Purpose: Identify SWOT  Example Evaluations  CDM Maintenance  CDM Annual Updates  CDM Data Integrity  CDM Management Performance  Issue Tracking/Resolution  Resource Inventories

Where do we go from here? 28  Challenges  Solutions  Resources

The Challenges 29  Time & Money  Skills & Processes  Impact of Change  Audit & Claims Defense  Projects, Priorities, and Politics

The Solutions 30  Unique for every environment  Personnel-driven  Costs to consider  Priorities  Level of Commitment

The Resources 31  Collaborative Efforts & Exec. Support  Process Improvement Strategies  Education  Data Analysis  Software Tools  Consulting Support

Summary 32  Hot Topics  2013 CDM Updates  Charge Management Processes  Dealing with the Challenges

Contact information: Rosemary Holliday (530) 550-0865 or (800) 831-3323 E-mail: rholliday@cdmpi.org Web Site: www.chargeassist.com 33