When a Comprehensive Chargemaster Review is complete, our clients experience many different improvements, including:
Reduction in denied claims due to coding problems
Increase in revenue due to more accurate coding and charging practices
Improvement to accurate charge capture
Increase in staff awareness of their impact on the revenue cycle
Greater understanding of the importance of accurate Chargemaster and Order Entry
Incessant Regulatory Changes and Denied Claims
During a Chargemaster Review at a large healthcare system, MedCom discovered the coding error that was causing an increasing number of failed patient claims to be rejected by Medicare due to the regulatory changes of the year. Patient bills were being sent to Medicare with the inappropriate HCPCS C-coded supply appended to the bill (device code edit). With more investigation, MedCom determined that the reason for this error was that pre-packaged supplies were being coded as a single line item when they needed to be reported as multiple coded supplies by Medicare regulations. MedCom performed a full-audit of these supplies and restructured the line items as explode charges, resulting in a stop-loss of denied claims while at the same time avoiding any additional burden during the charge capture process, the result an increase of $1.5 million to net revenue.
Lost Reimbursement and Medicare Codes
During a Chargemaster Review, MedCom identified a problem in a hospital that was not utilizing a HCPCS code to report Medicare screening PSA and occult blood testing. Because diagnosis codes are not a Medicare covered service when reported as a CPT code, the hospital was losing reimbursement. Upon discovering the usage of CPT codes, MedCom recommended the steps for using the correct HCPCS code to obtain proper reimbursement at $45 per claim.
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