Compliance Issues for the Chargemaster by Duane C Abbey

Description:-
The chargemaster is both a direct and indirect target of compliance and thus various types of audits.  Hospitals should periodically take the time to examine their chargemasters from a compliance perspective.  This means examining and review various CDM policies and procedures (P&Ps) which must dovetail to coding P&Ps as well as billing P&Ps.  Issues such as transparent pricing, proper use of revenue codes, cost report interface, coding interface, billing interface, supply categorization, etc. must all be considered.  A systematic process for auditing the chargemaster relative to this host of compliance issues is discussed.

Why is the chargemaster a direct target for compliance?

Are formal, chargemaster policies and procedures important?

Should the chargemaster be routinely reviewed as a good compliance practice?

What is all the concern about archiving the chargemaster?

Is statutory and contractual requirement for the chargemaster significantly different?

Why has chargemaster pricing become such a hot compliance issue?

How can we know that our chargemaster is in compliance?

Are the revenue codes really important?
Teleconference/Webinar Objectives:-
To review the purpose, function, and organization of the chargemaster.
To appreciate that the chargemaster is both a direct and indirect concern for compliance.
To appreciate the difference between statutory and contractual compliance issues.
To discuss the attributes that are necessary to maintain chargemaster compliance including revenue codes, CPT/HCPCS codes, and pricing.
To appreciate the compliance areas that may be reviewed by external auditors and governmental entities including the RACs.
To appreciate the indirect impact that the chargemaster has on other compliance concerns including coding, billing, and payment.
To understand the differences between separately charging and separately billing or separately reporting.
To appreciate the proper use of revenue codes and the potential impact on the cost report.
To discuss the development of CDM P&Ps which must properly correlate to coding P&Ps and billing P&Ps.
To review various compliance issues related to the CDM and the policy decisions that must be made to maintain compliance.
To appreciate different levels and forms of guidance from CMS, which sometimes conflict.
Teleconference/Webinar Outline/Agenda:-
Overview of the Chargemaster
Role, Purpose, Function, and Organization
Chargemaster Interfaces
Direct versus Indirect Compliance Concerns
Types and Levels of Compliance Concerns
Statutory Requirements
Medicare
Other Governmental Programs
Contractual Obligations
In the Contracts
References to Companion Manuals
Chargemaster Compliance
Internal Code Sets
Correlation of Line Items
Proper Assignment of Revenue Codes
Proper Pricing and Charge Structures
Developing Proper Cost-to-Charge Ratios (CCRs)
Indirect Areas of Chargemaster Compliance
Cost Report
Cost Accounting
Correct Coding
Proper Claim Generation
Governmental Auditing Programs
Levels and Types of Rules and Regulations
Ambiguous and Conflicting Guidance
DOJ and CMS
RACs
Sources for Further Information
Prerequisites for Participating:- 
General knowledge of the chargemaster.
Suggested Attendees:-
Chargemaster Personnel, Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Cost Report Preparers, Compliance Officers and Compliance Personnel, Auditing Personnel, Revenue Cycle Personnel, Clinical Service Providers, Financial Analysts, Compliance Personnel, Physicians and Other Interested Personnel.