Charged Up About Chargemaster Automation

Karen Minich-Pourshadi, for HealthLeaders Media , November 1, 2010

Moreover, the software flags exceptions to industry best practices and allows hospital staff to manage those exceptions rather than getting mired in complex details. It also enables staff to identify the exact sources of the problems and correct them before they become patterns of behavior within the charges. A much more efficient approach than correcting the same errors over and over again later, after claims have been denied or rejected. Plus the automated process allows providers to see losses of revenue that would be missed by traditional scrubbers.

“Just 12 months prior to adding the Craneware software we had a consultant check our chargemaster and we were told that it was in relatively good shape but what we found intriguing was that the consultants never talked about the things we were not charging for,” says Barry. “This software is doing a better job of identifying opportunities.”

Indeed automating their chargemaster has given their bottom line a boost—they’ve been able to identify more than a few opportunities over the last year.

I understand that financial leaders have a lot of cost-cutting measures on their minds and the supply chain offers the low-hanging fruit; however automating your chargemaster has the potential to unveil millions of dollars in reimbursement—it’s not low hanging fruit but I think you’ll find it’s a more ample harvest.

Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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2 comments on "Charged Up About Chargemaster Automation"

Michael (11/1/2010 at 6:00 PM)
Couldn't agree more Jill. The software from Craneware is probably the best solution to automate how a Provider uncovers potential gaps in their CDM, however I'm not certain any Provider would use the software exclusively to add charges unless they've done their due diligence of the operation to determine the validity of what the software found. I believe the Craneware software also helps identify trends and revenue gaps by inspecting claims as well as the links between supply chain spend and reimbursement. In these cases - I suspect the software is only automating the process of finding the potential gaps and missing links. It's up to the Providers' Revenue Integrity team to resolve any issues and fix the gaps, but their job is now spent fixing and not trying to find needles in a haystack. Software is only as good as the sustainable process build around the solution.

Jill R (11/1/2010 at 2:53 PM)
Let me start off by saying Craneware is a great product and worthwhile investment, however, Providers need to use some discretion when adding charges that may be all-inclusive or perceived as unbundled. While it may appear that there is greater potential for reimbursement, indeed you may be increasing your potential for denials, thus unrealistically inflating your AR, and expected Reimbursement. One of the modules Craneware offers is a product that looks at charging patterns nationwide and tells you, for example "75% of providers who charged for X, also billed for Y and Z". While this may invaluable for those whose CDMs are lacking in the appropriate macros, others may just be padding their claims with non-payable charges and engaging (unwittingly) in non-compliant billing practices, putting themselves at risk possibly for fraud/abuse investigation. I would use a GREAT deal of caution with this product. Just because 75% of hospitals do it, does NOT mean they are doing it the RAC audits have proven. As with everything, buyer beware, if it sounds too good to be true, it probably is. I am in no way suggesting that it is better to leave money on the table, far from it, just that you use some common sense and in all things, do what is right.......that's why it's called Revenue INTEGRITY.




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