Chargemaster Analyzer: Updateable, CD-ROM, Data & Software
CD-ROM + data, software, code updates, automated analysis and validation tools + quarterly updates
Ingenix / Thomson Delmar
Elsevier Health Sciences
(click below for complete up-to-date software, tools, data and updates on CD-ROM)
The hospital chargemaster is a critical revenue cycle tool that needs to be monitored and updated continually.
Chargemaster inaccuracies can result in rejected claims, inappropriate reimbursement under OPPS, errors of omission, under- or overcharging and the potential for audits and fines due to compliance risks.
Chargemaster Analyzer is a valuable desktop solution that helps hospitals maintain an accurate and complete chargemaster for Medicare billing purposes and leads to fewer denials and more accurate outpatient reimbursement.
Comparative charge, APC payment and fee data. Compares your charges with Medicare reimbursement and price and cost data for hospital outpatient services in your cost-based statistical area (CBSA) to help you identify potential additional revenue. It also helps you to justify prices established for procedures within the selected market.
Best practices tool. Helps you find CPT and HCPCS Level II codes that may be missing and identify additional revenue potential within each clinical department’s segment of the CDM file.
Quarterly updates. Provide the latest CPT codes, HCPCS Level II codes and payment rates in effect when you need them. Quickly update your chargemaster and avoid costly mistakes.
Minimize denials and improve revenue cycle performance. Keep your CDM in check for inappropriate revenue codes, CPT and HCPCS Level II codes and modifiers, and missing related procedures. Cross-references automatically identify which code(s) to use to replace a deleted code.
Auto-analysis of imported CDM file. Increases productivity by automating the repetitive process of performing chargemaster code and data reviews, analysis and updates.
All-inclusive CDM validation under outpatient PPS rules. Helps you analyze and validate your hospital’s chargemaster file against a comprehensive set of medical codes and data sets, hospital payment tables and coding relationships. Attain the most accurate and up-to-date review and analysis for Medicare billing and reimbursement purposes.
Analyze and compare CDM data more effectively. Use the code view “Not Billable to Medicare” to instantly identify all codes that are not billable to Medicare under OPPS.
Multiple data sorts. Sort data by hospital utilization statistics to identify line items that have the biggest impact on reimbursement.
CCI unbundled edits are highlighted to indicate which CPT/HCPCS codes can be billed together. Highlights hospital outpatient CCI edits and code relationships. This will help you know which codes can be billed together with appropriate documentation, which are mutually exclusive and which require a modifier.
OPPS payment lookup tables. Helps you locate hospital-specific APC payments and fee schedule amounts with ease.
You can view of sample of some screen shots of this software, from a previous year's edition, here:
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Carol Endahl has 25 years' experience in health care, maintaining expertise in hospital and institutional billing and payment, claims processing, revenue cycle management and patient accounts operations, and Medicare coverage and reimbursement issues. She has authored many publications and newsletters, including the UB-92 Editor, Medicare Billing Compliance Guide, Medicare Billing Compliance Reference Manual, Medicare Secondary Payer Billing and Reimbursement Guide, and How to Plan and Manage Patient Accounts. Prior to working for Ingenix, Ms. Endahl was a supervising management consultant with a Big 5 accounting firm and an inpatient claims processing supervisor with the New York State Department of Social Services Medicaid program.
Please remember: The government no longer allows a grace period for annual code sets. The new HIPAA Transaction and Code Set Rule requires providers to use national medical code sets that are valid at the time that a service is provided. ICD-9-CM code revisions become effective October 1st each year while CPT and HCPCS code revisions become effective January 1st. In order for you to meet this requirement, you must have the revised CPT, HCPCS, and ICD-9-CM codes in your possession before the implementation dates. The best way to do this is to order your code books early. Review current coding resources.
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