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

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

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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

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CHAR CHARGE GE MASTER MASTER ISSUES & PRIORITIES ISSUES & PRIORITIES

AAHAM WESTERN REGION CHAPTER

Presenter: Rosemary Holliday May 2013

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  • Hot Topics
  • 2013 CDM Update Highlights
  • Charge Management Processes
  • Today’s Charge Master Challenges

Agenda

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Hospital Pricing in the Spotlight

 Recent News:

 “Bitter Pill” and “Killer Apps”  Medicare Provider Charge Data  Pricing in the Press

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Strategies

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Take the offensive

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Ensure defensible charge data

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Pricing image ‘self- check’

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Identify basis for pricing

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Realistic Perspective

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Develop a plan

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Hospital Pricing in the Spotlight

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Pubic Relations Processes Data

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Revisiting 1Q2013 Updates

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

 What Happened?

 CPT & HCPCS code changes  CMS payment system updates  Implementation by payers & providers  Operational and reimbursement impact

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Revisiting 1Q2013 Updates

 Why was it Challenging?

 Quantity and type of updates  Timelines  New charge structures & repricing  New documentation and charge capture  Limited payer guidance

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Revisiting 1Q2013 Updates

 What was the outcome?

 Weak CDM processes exposed  Collaborative relationships strained  Department engagement taxed  ‘Stars’ &‘black holes’

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2013 CDM Updates

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Top 10 Areas of Impact

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Psychiatry

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

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Rehab Services

 Caps  Threshold  MPPR  Functional Reporting  CMS Claims Edits

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Cardiovascular System

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

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Diagnostic Imaging

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

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Pathology & Laboratory

 Code updates

 Miscellaneous Code updates  Molecular Pathology

 Regulatory Updates  CA Laws  H.I.S. Integration

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Neurology

 Coding Updates

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

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Pharmacy

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

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RT / Pulmonary Medicine

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

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Ophthalmology

 New & Established Definition  Other Code Updates  MPPR

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E&M Codes

 Visit Codes – Trends & Politics  C4 & TCM Services  Pediatric Critical Care Patient Transport

Supervision

 OPPS Guidance & Payments

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Other updates

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

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Remaining 2013 Priorities

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

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Charge Management

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Defining “Charge Management”

“Oversight and control of all aspects of charge data throughout the organization”

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Assessing Charge Management

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 What’s our approach?

 Reactive?  Proactive?  Somewhere in-between? Reactive Proactive

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Assessing Charge Management

 Quantify charge data quality

 Quick Assessments  Indicators of accuracy  Third party feedback  Are assumptions correct?

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Evaluation Techniques

 Purpose: Identify SWOT  Example Evaluations

 CDM Maintenance  CDM Annual Updates  CDM Data Integrity  CDM Management Performance  Issue Tracking/Resolution  Resource Inventories

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Where do we go from here?

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  • Challenges
  • Solutions
  • Resources
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The Challenges

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

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The Solutions

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

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The Resources

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

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Summary

  • Hot Topics
  • 2013 CDM Updates
  • Charge Management Processes
  • Dealing with the Challenges

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Contact information:

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