Determine if All Revenue Codes and CPT/HCPCS, Modifiers Codes Are Up-to-Date and Being Properly Reported. Be Prepared to Appreciate the Concept of Transparent Pricing and the Changes That Must Be Made By January 1, 2021.

The chargemaster is a lynchpin within the overall revenue cycle.  Keeping the chargemaster up-to-date both for reimbursement as well as maintaining proper compliance is necessary.  The chargemaster is a direct and indirect target of compliance for both governmental programs and private third-party payers.  Chargemasters are complex and can be organized in different ways.  Added to this overall mix is the continuing controversy over hospital pricing strategies.  A carefully crafted systematic process is necessary to audit a chargemaster to make certain that various concerns are met.  The chargemaster must also be organized in a way that hospitals remain financially viable.

Join expert presenter, Duane C. Abbey, CFP, in this 90 minutes webinar to Review Coding Changes for CPT, HCPCS, Modifiers and Revenue Codes. As prerequisites for participating, a general understanding of the chargemaster and the charge development process is assumed.

Session Objectives:-

• To Review The Chargemaster As A Financial Tool
• To Determine if All Revenue Codes and CPT/HCPCS Codes Are Up-to-Date and Being Properly Reported
• To Understand Statutory Compliance Surrounding the Chargemaster
• To Appreciate the Contractual Obligations That Hospitals Have Concerning the Setup and Use of the Chargemaster
• To Have A Systematic Process to Review and Evaluate the Chargemaster
• To Discuss The Many Compliance Concerns Surrounding the Chargemaster Including Development of Pricing and Charges
• To Appreciate the Concept of Transparent Pricing and the Changes That Must Be Made By January 1, 2021
• To Appreciate the Very Different Requirements Made By Different Third-Party Payers for Coding, Billing and the Chargemaster
• To understand how the Chargemaster affects and is affected by different payment systems including DRGs, APCs, MPFS and special hybrids.
• To Review Action Steps that Chargemaster Coordinators Can Take To Review and Update the Chargemaster and Make Improvements
• To Review Coding Changes for CPT, HCPCS, Modifiers and Revenue Codes

Session Agenda:-

• Overview of the Chargemaster Form, Structure and Contents
  • Billing System Influence
  • Special Service Area Requirements
  • Chargemaster Interfaces
  • Pricing, Charge and Cost Report Issues: Cost-to-Charge Ratios, Tiered Pricing Formulas,
  • CDM Interface to the Cost Report, Transparent Pricing – Changes for 2021
  • Payment Systems: DRGs and IPPS, APCs and OPPS, RBRVS and MPFS, Special Hybrids – ASCs, Provider-Based Clinics
  • 2020 Coding Systems – Revenue Codes, CPT & HCPCS Changes: Revenue Code Concerns, Modifier Changes
• Chargemaster Compliance Concerns
  • Statutory: Medicare, Medicaid, HIPAA TSC
  • Contractual: Private Payers, Types of Contracts and Payment
• Chargemaster Updating Review Process for 2020
  • Personnel – Team
  • Update Audit Objectives, Type of Audit, Conduct of Audit, Results from Audit
• Chargemaster Policies & Procedures – Judgment Metrics
• Special Situations – Example and Case Studies
• Chargemaster Coordinator Action Steps

Session Goals and Outcomes:-

• How do you keep up with all of the CPT/HCPCS coding changes and their impacts on the chargemaster?
• How do you balance revenue optimization with maintaining compliance?
• Why is hospital pricing such a sensitive area? What is all this talk about transparent pricing?
• Should there be written chargemaster policies and procedures? Chargemaster decision areas?
• Why are the revenue codes sometimes ambiguous?
• How should supplies be handled? What about drugs and injections? What about nursing services?
• Should we be concerned about the cost report?
• Are there different kinds of chargemaster audits? How should clinical personnel be involved in chargemaster audit?

Who Should Attend:-

• Chargemaster Coordinators, Compliance Personnel
• Billing and Claims Generation Personnel
• Patient Financial Management Personnel, Financial Analysts
• Cost Accounting Personnel, Cost Report Personnel
• Managed Care Contract Personnel, Internal Audit Staff
• Chief Financial Officers, Financial Planners
• Chief Compliance Officers, Utilization Review Staff
• Revenue Cycle Specialists, Revenue Enhancement Personnel
• All Other Hospital Personnel Interested in the Chargemaster