When building a charge description master (CDM), the care taken to describe each item of service can have monumental impact on the hospital’s ability to capture charges and get reimbursed. Even more importantly, the CDM can affect the hospital’s capacity to perform strategically, whether conducting research, studying its care and quality practices, engaging in mergers, participating effectively in consortium purchasing, or consolidating operations under a corporate umbrella.
The Centers for Medicare and Medicaid Services (CMS) make frequent changes to hospital coding and payment regulations. Drug Administration changes are effective for services provided to Medicare outpatients on or after January 1, 2006.
The Ambulatory Payment Classification (APC) used to reimburse for Nuclear Medicine procedures under The Outpatient Prospective Payment System (OPPS) does not include the cost of many radiopharmaceutical agents. For this reason, hospitals need to know when they must generate separate charges for radiopharmaceuticals or isotopes that are used in conjunction with these procedures.
Hospitals should perform an “annual check-up” of their receivables management departments in order to ensure the integrity of processes, performance, and workflow. The “health” of this department has a dramatic impact on the fiscal health of the organization. Preventive maintenance translates into optimized billing, faster payment, compliance with regulatory requirements, and reduction in lost charges.