Code connections

May 22, 2014

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Why might mapping each charge code to an item master number be so much more effective and efficient for healthcare providers and suppliers alike? Nine experts share their reasons.

Supply charges can often be high-dollar items, and a lack of proper handling can result in lost revenue, under billing, lost opportunities for maximum reimbursement.

– John Dragovits, Senior Vice President and General Manager, Revenue Cycle, Allscripts Healthcare Solutions Inc., Chicago

By mapping the charge code to an item allows the healthcare provider can get to a greater level of detail to get the codes right up front. This detailed information allows the provider to have more pricing transparency and optimize its reimbursements.

It also can help prevent missed charges for high-dollar implants, or using the wrong price and/or wrong HCPCS code resulting in missed revenue opportunities and possible compliance issues.

– Amy Amick, President, Revenue Cycle Management Segment, MedAssets Inc., Alpharetta, GA

The linking of files throughout an organization will ensure consistent pricing, ordering and billing. Providers should immediately realize easier and more efficient charge capture, resulting in reduction in billing errors and improved charge lag. Suppliers should see a cleaner process in both ordering and invoicing of supplies.

– Karen England, Revenue Cycle Consultant, Ingenious Med, Atlanta

You would be mapping multiple item master numbers to a charge code. That would be more efficient in terms of data analysis, but it would not necessarily be more efficient for suppliers. The information, regardless of whether it is linked or not, could still be fed to the EMRs to inform providers.

 – Jeffrey Rose, M.D., CMIO, TriZetto Corp., Denver

Outside of healthcare, we live in a world of just-in-time inventory management. Major consumer retailers and service providers (Amazon, McDonalds, etc.) don’t keep more on the shelves than they need, and they do so by tightly integrating their supply chains to share information. This lowers the cost of inventory for everyone and gives suppliers better confidence in deciding future manufacturing. Healthcare, plagued by long cycle reimbursement times, could benefit across the board by shortening and integrating our supply and revenue cycle functions. 

– Patrick Campbell, Product Manager, MedAptus Inc., Raleigh, NC

Linking the charge code to an IMF could work if the system was set up for the complexities of acute-care billing. This is a large endeavor, even more so considering ICD-10, despite the delay. By moving into a new revenue cycle frontier, the risks become great considering that healthcare system are operating on low margins and typically lower cash on hand than other industries. The disruption of cash flow and the attendant issues (timely filing denials and the amount of potential back-log work) make the financial risks potentially untenable. 

– Robert Magnuson, Principal Advisor, Impact Advisors LLC, Naperville, IL

Mapping each charge code to an item master number is much more effective and efficient for healthcare providers and suppliers alike. This one-to-one approach provides clarity for procedure costs and quality-of-care metrics. The chargemaster structure is the key to this effective strategy. The chargemaster and its charge data serve as the basis for accurate reimbursement, charge compliance, as well as divvying up payment for the various portions of care in a bundled-payment environment.

– Kathy Schwartz, Product Manager, Craneware Inc., Atlanta

Having universal data standards using GS1 with a GTIN on every product would be the first step to effective and efficient healthcare. This would make management of the IMF more manageable. As for having a single charge code for each item, it is not realistic because one item can be related to multiple charge codes based on the procedure, diagnosis or billing location. It would be beneficial to have a cloud of content that is flexible and robust enough to pre-populate more than one charge code based on common variable values (HBCS, ICD 10, UNSPSC) using an algorithm-based solution. This type of heuristic approach could radically alter and optimize the process to enable the one to many relationships of items to possible codes. Not only can a supply be used for multiple procedures on the inpatient side under a unique set of codes, it can also be used on the outpatient side across the continuum of care codified based on the class of trade or care site. A prepopulated database would make it easier for the revenue cycle team to select the proper code based on the patient’s diagnosis or procedure. This type of universal registry does not exist today but would be a wonderful industry resource.

– Patrick Flaherty, Director, Supply Chain Management, University of Pittsburgh Medical Center (UPMC)

  • Clinical data gathering and reduction in wasted tests.
  • Provide streamlined patient care.
  • Be able to do better clinical analysis of patient care.
  • Link physicians together so there is better communication on patient care.
  • Reduce mistakes due to information not shared by patient to physician.

– Patrick DeAngelo, vice president, technology and process, McKesson Business Performance Services

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