Situation
Because the Centers for Medicare and Medicaid (CMS) has not established the criteria facilities should use to report the technical component of emergency room (evaluation and management - E/M) visits, each facility is required to develop and implement reporting criteria for charging emergency room encounters. In an effort to become compliant with CMS billing and coding requirements as well as to be RAC ready, McKenzie Hospital requested a review of its emergency room chargemaster. Given Wipfli’s extensive expertise in performing chargemaster reviews, Wipfli was selected to assess McKenzie’s ED CDM.
Strategy
Wipfli’s proven methodology was utilized. We promptly assessed McKenzie’s CDM and related tools, as well as interviewed billing, coding, and nursing staff to review the billing process. The results led to:
- Identification of unbilled services such as surgical procedures, observation, bed side services (infusions/injections), and other miscellaneous services.
- Improvements to the existing charge ticket design.
- Several different easy-to-use options/methodologies for McKenzie to determine compliant E/M levels.
- Realization of clinical staff’s need for further education around specific issues such as the hierarchy of infusion and injection reporting.
Benefits
With the appropriate tools, procedural knowledge, and timely and accurate financial information, McKenzie Hospital was able to operate more efficiently and more profitably. The hospital:
- Increased gross accounts receivable by $70,000 a month.
- Received an updated chargemaster with added procedures and correct codes.
- Educated its ED clinical staff on focused billing issues.
- Improved its billing efficiency.
- Increased RAC preparedness.
