F I N D I N G N E V E R L A N D : N A V I G A T I N G C H A R G E - PowerPoint PPT Presentation

F I N D I N G N E V E R L A N D : N A V I G A T I N G C H A R G E M A S T E R S T A N D A R D I Z A T I O N New Jersey HFMA June 9, 2015 WeiserMazars LLP is an independent member firm of Mazars Group.

A B O U T T H E S P E A K E R S Stacey Harper is a Senior Manager in the Health Care Advisory Services Practice of WeiserMazars LLP. Stacey’s background includes assessment and implementation of process improvement initiatives across the revenue cycle including charge capture, patient financial services, denials, strategic and transparent pricing, and Stacey Harper, RHIA, CPC, CPMA compliance. She is a Registered Health Senior Manager Information Administrator (RHIA), Certified WeiserMazars LLP 33 West Monroe Street, Suite 1530 Professional Coder (CPC), and Certified Chicago, IL 60603 Professional Medical Auditor (CPMA). 412.613.0309 Stacey.Harper@WeiserMazars.com WeiserMazars LLP is an independent member firm of Mazars Group.

A B O U T T H E S P E A K E R S Taylor Pedone is a Senior Consultant in the Health Care Advisory Services Practice of WeiserMazars LLP. Taylor’s background includes assessment and implementation of process improvement initiatives across the revenue cycle including charge capture, patient financial services, denials, strategic and transparent pricing, and Taylor Pedone, CPC, compliance. She is a Certified Professional Senior Consultant Coder (CPC). WeiserMazars LLP 33 West Monroe Street, Suite 1530 Chicago, IL 60603 440.666.0930 Taylor.Pedone@WeiserMazars.com WeiserMazars LLP is an independent member firm of Mazars Group.

L E A R N I N G O B J E C T I V E S 1. Charge Master Standardization Overview 2. Key Considerations for Charge Standardization 3. Pricing Strategies for Multi-Hospital Systems 4. Implementation Strategy 5. Case Study – Six Hospital System 4 WeiserMazars LLP is an independent member firm of Mazars Group.

W H A T I S A C H A R G E M A S T E R S T A N D A R D I Z A T I O N ?  Detailed line by line review of each facility’s charge master for accuracy and compliance – Revenue Codes, CPT/HCPCS codes, Billing Descriptions, Usage  Aligning facility charge masters with best practices to result in one cohesive charge master  Aligning departmental and system-wide charge master and charge capture policies and procedures  Consistent pricing strategy (not necessarily prices) 5 WeiserMazars LLP is an independent member firm of Mazars Group.

B E N E F I T S O F C H A R G E M A S T E R S T A N D A R D I Z A T I O N  Consistent CPT/HCPCS, Revenue Code Assignment and Billing Descriptions – Ensure accurate coding and appropriate billing  Improved charge capture – Clinical manager involvement in standardization process  Uniform price and volume analysis – Improves revenue comparison and charge capture trending  Improved collections and reduced third-party denials – Compliant procedural coding, clean claims  Reduced risk of payer audits/penalties – Compliance, policies & protocols  Guidance Provided by protocols – Formal protocols, improved consistency  Easy updates on a global level Streamlined process, central repository – 6 WeiserMazars LLP is an independent member firm of Mazars Group.

S T A N D A R D I Z A T I O N P R O C E S S Develop a chargemaster Line by line CDM review Implementation and workgroup & project with clinical Maintenance leader departments Affected departments: Revenue & Usage review Compliance, Finance, Managed Charge capture method/process Care Contracting, Billing, Clinical CPT/HCPCS code and Revenue Annual review for CPT/HCPCS Departments, Care Management, Code accuracy deletions & additions Patient Access, Revenue Integrity, Billing description accuracy Policy for new charge generation HIM/Coding, IT Review for gaps and Initial Standardization & Go- redundancies Forward Maintenance 7 WeiserMazars LLP is an independent member firm of Mazars Group.

C R U C I A L W O R K S T E P S • Develop a chargemaster team • 2-6 individuals focused on maintaining the chargemaster and protocols, verifying ongoing compliance, and a departmental resource • Assign a project leader • Representation from each hospital • Assign a project champion / sponsor • Ensure system-wide support with backing from CEO/CFO • Set timelines • Ensure project remains on track with realistic goals and timelines • Weekly/Bi-Weekly project meetings • Develop a process for maintenance • Ongoing review of chargemaster accuracy, data review, and usage trending 8 WeiserMazars LLP is an independent member firm of Mazars Group.

K E Y C O N S I D E R A T I O N S F O R S T A N D A R D I Z A T I O N  Will the hospitals be standardized on the same billing/clinical system(s)? – Both the billing and clinical system affect standardization Affects actual process and capture of the charges as well as how charges are processed – Can be accomplished on same or different systems (far more complexity) –  Is there common leadership over similar departments across hospitals? Requires leadership to work collaboratively for ultimate success –  Migrate to best practice Avoid converting hospitals to “chosen” hospital’s structure and processes – Instead move toward best practice and encourage adoption by all facilities –  Charge masters can be completely standardized yet still maintain separate pricing by facility or other factors WeiserMazars LLP is an independent member firm of Mazars Group.

O V E R A L L I M P L E M E N T A T I O N S U G G E S T I O N S • Make critical decisions upfront • Pricing, Contracting, Billing/Clinical Systems, Leadership Roles • Use pilot departments who are engaged and not adverse to change • Identify ways to measure value and outcomes as project progresses • Encourage detailed financial analytics • Use “parking lot” mentality to control scope • Overcommunicate expectations, timeline and involvement of clinical departments • Hold project leaders, sponsors and champions responsible for outcomes 10 WeiserMazars LLP is an independent member firm of Mazars Group.

P R I C I N G C O N S T R A I N T S • Academic, Urban, Rural, Community Hospitals merging into one Health System can be problematic • How do you address pricing in a world of transparency & defensibility? • How do you address varying cost structures, patient acuity and competition? • How do you standardize charge master and charge structure in this environment and ensure net neutrality (or net revenue improvement)? 11 WeiserMazars LLP is an independent member firm of Mazars Group.

S T R A T E G I E S F O R P R I C I N G • Requires significant involvement and input from Executive Leadership regarding vision and strategy • Where do you want to be in the market place? • Are your Hospitals different enough to warrant different pricing? • Do you Managed Care Contract restraints? And do they vary by facility? • Do you want to be the low cost provider or have specific service lines that warrant being above/below market? • Do you have reliable cost data? • Do your variances in cost structure by facility make sense? 12 WeiserMazars LLP is an independent member firm of Mazars Group.

S T R A T E G I E S F O R P R I C I N G • Consolidated pricing across hospitals versus tiered pricing categories (i.e. rural, urban, academic) • Consistent methodologies across Departments with varying mark-ups above cost (most effective in supplies, OR, pharmacy type departments) • Consistent pricing methodologies are far easier to implement with consistent charge structure and departmental processes across facilities • Consider phased approaches to updating prices (over 1-5 year period, staggering departments, etc.) • Set floors and ceilings for changes and perform detailed analytics on net impact at a procedure, service line/department and facility level by each payor to fully grasp impacts 13 WeiserMazars LLP is an independent member firm of Mazars Group.

C A S E S T U D Y – S I X H O S P I T A L S Y S T E M WeiserMazars LLP is an independent member firm of Mazars Group.

C A S E S T U D Y - S I X H O S P I T A L S Y S T E M • Six hospital system • More than 17,500 employees and 4,600 credentialed physicians • 1,725 Hospital Beds • Annual volumes • 200,000 Emergency Room Visits • 90,000 Inpatient Discharges • 8,000 Newborn Deliveries • 25,000 Inpatient Surgeries • 57,000 Ambulatory Surgeries • 10,700 Cardiac Catheterizations • 4,000 Coronary Angioplasties • 1,500 Open Heart Surgeries • In process of migrating each of its six hospitals to new integrated EMR • Wanted to review charge capture processes and structure and standardize across the Health System 15 WeiserMazars LLP is an independent member firm of Mazars Group.

C A S E S T U D Y - S I X H O S P I T A L S Y S T E M • Review identified the following initial variances: • Dramatic variances in Emergency Department acuity level assignment • Variances within peri-operative services to include Anesthesia, OR, Recovery, Endoscopy • Variances in most other clinical departments across the Health System relative to either charge master build and/or process • Compounding factors: • Hospitals on different clinical systems • Varying payor mix, patient acuity and complexity of service offerings by facility • Variances in leadership and executive presence 16 WeiserMazars LLP is an independent member firm of Mazars Group.