December 15, 2014 Emerging Issues in Billing and Coding Volume 1, Issue 2

Who, What, or Where is the CHARGEMASTER?

To find out, I went to the source: Stephanie Kanniard, Master of the Chargemaster, Analyst Extraordinaire!

The Chargemaster (CDM) is basically an electronic dictionary that includes all procedures,

services, supplies, and drugs that are billed by the hospital (BWPO is separate). It contains important

information regarding each service that insurance companies require, such as price, CPT, etc. The CDM

makes it easier to link information from BICS (where we enter charges) onto an electronic claim form

(which we send to insurance companies). BWH has one chargemaster, but departments have their own

accounts or “cost centers.” Derm alone has at least 5 cost centers, for all our sites. (cont’d next page)

Like this newsletter? Have a story idea or suggestion? Contact the Editor at kfuss@partners.org.

Contributions welcome!

Derm Daily Digest Appearing Quarterly since September 2014

Contents:

o Love Potion #59

o Who, What, or Where is the

Chargemaster?

o Countdown to Epic

o Interview with Tim Hogan,

HVMA Chief of Compliance

o Billing Limericks!

o Quotes and Quips

Love Potion # 59 This quarter, it’s a special shout-out to everyone’s least favorite

modifier! This wishy-washy, indecisive coding afterthought has

more rules and exceptions than a game of Dungeons and Dragons

(too nerdy?). But overlooking or ignoring this one little code causes

claims to be denied, and patients can receive bills because of it.

The gist of the 59 modifier is: “Distinct Procedural Service.”

This signals to the coders that 2 (or more) unrelated, completely

separate procedures were performed. But the $50 million dollar

question: when is it needed, and when is it not?!?

Hint: The answer to that question fills up an entire book. By the

time you finish reading it, the rules will have changed anyhow!

Only attach to procedures?

Never attach to E/M or

Diagnosis (ICD-9) codes?

Am often confused with

that other modifier, 25?

(we look nothing alike!)

Attach to the 2nd and any subsequent instances of a

repeated procedure? (e.g. 11402, 11402 +59)

Don’t attach to closures when combined with an exc?

Attach to 17000 when combined with 17110, but

attach to 17110 when combined with 17004? AHHH!

Cause claim denials, and result in patients

being wrongly billed due to our mistake? :(

Show the 59 some love this holiday season and don’t forget your 59 Modifier Cheat Sheet !

COUNTDOWN TO EPIC

It’s coming...

It will be EPIC!

5 months 16 days 13 hours

or 167.5 days or 23.9 weeks

A Limerick a Day Keeps the Doctor Away ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ It happens so often in billing Patients are curt, confused and unwilling Charged all possible fees From their head to their knees If we can bill their insurance, it’s thrilling! ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ridiculous, outrageous, absurd Are how some describe their charges incurred The complexity perplexes No wonder it vexes! Sometimes folks just want to feel heard. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ There once was a patient from Boston Who came in to see dear Dr. Watson She said with a grin, “So how have you been?” He said, “Doc, that depends what it’s costin’!”

Compliance departments often take on the

personality of the chief compliance officer – for instance, a

lawyer like Tim will focus more on policy & regulation, while

others might emphasize ethics, reporting, quality and

consistency. Their goal is to make compliance as easy as

possible for physicians so they can spend most of their time

taking care of patients and doing what they love.

FRAUD: Now I have your attention! That’s the F-

word in compliance. Also, watch out for the bogeyman!

(That’s the OIG, Office of the Inspector General). But don’t

worry – mistakes aren’t crimes, only “knowing and willful

misconduct.” Anywhere from 5-30% of Medicare payments

are based on incorrect data, yet only 2-3% are intentional

fraud. And with so many grey areas, it’s no surprise that

medical coders disagree about 50% of the time!

“If you ask 2 physicians, you’ll get 3 answers.”

- Tim Hogan

Quotes and Quips:

“Change is hard because people overestimate the value of what they

have -- and underestimate the value of what they may gain by giving

that up.” - J. Belasco & R. Stayer, 1994

A Chat with Tim Hogan, Compliance & Privacy Officer

at Harvard Vanguard Medical Associates

Health care compliance meets at the nexus between cost,

quality, and ethics, which are all interrelated and impact

people at every level. It used to be, “Whoever doesn’t show

up for the meeting... gets assigned to do compliance.” Yet

compliance officers look at 3 crucial questions which no other

role exclusively focuses on:

1) Does it break the law?

2) Does it violate an organization standard?

3) Does it make you feel uneasy or nervous?

Chargemaster (cont’d from first page)

The CDM is a way to organize and route

revenue to the right department – when

Dermatology 506410 performs cryo (17110),

the charge code 4101861 is linked to this

department to ensure that when the claim is

paid, the revenue goes back to Derm 506410.

With Epic, the CDM will remain but it will work

differently. Any changes will have to be

requested from Partners e-Care through the

ChargeMaster team, and the technical

infrastructure will be different.

Stephanie manages the entire chargemaster

for Dermatology. She constantly reviews

codes to ensure they are set up correctly, or

checks on claims to see if charge codes show

correctly. She often goes out to cost centers

to train department heads and coordinators

on how to use the codes properly. Imagine if

we had to do all of this without computers!

“Updating the CDM is really easy. I can either

manually change information in BICS or download

a file into BICS with my changes. However,

maintaining the CDM is a little more involved since

it requires good eyes.”

- Stephanie Kanniard, Revenue Integrity Analyst