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Claims and Coding Collect more money

For other organizations looking to establish corporate coding, charging and claims standards, John Whitesel, senior fi nancial consultant at Bob Secours, says resources and a governance structure are important. Limited resources can significantly impact a health system’s ability to successfully manage the chargemaster file. Whitesel recommends putting supplementary staff members in place before beginning the standardization process. Ideally, these employees would take charge of the CDM and remain in that position after the standardization changes take effect.

“It’s important to get any additional CDM staff on

board before undertaking the standardization work itself,” says Whitesel. “It will make the process run smoothly and help the organization get through the implementation phase, which is critical for long-term results.”

In addition, it’s essential to establish a consistent maintenance process for new and existing supplies by creating open lines of communication between the revenue and procurement teams. Now that Bon Secours has aligned the two departments, items marked “non-billable” in the past were found to be billable and worth millions of dollars. “Initially, many charges that were perfectly legitimate

weren’t captured because employees across the system didn’t know that they could charge for them,” says Whitesel. “Through consistent, open communication, we’ve also reduced compliance and billing risk on many supply charges.”

CDM management tips • Build a bottom-up structure for shared ownership of standards and decisions to ensure commitment across the organization.

• Consider multiple committees to ensure that all func- tions are covered; it’s especially important to have an implementation committee so that the hard-won standards don’t just become a “book on the table,” but rather are implemented and practiced.

• Establish a written set of guiding principles at the beginning of the standardization process in order to keep perspective throughout the detailed decision- making process.

• Take advantage of the opportunity to build a team. At Bon Secours, some of the people who didn’t know each other before the standardization initiative are now regularly sharing advice and best practices.

• Think big: Bon Secours took the opportunity to implement multiple projects at a time and is seeing the benefi ts in all areas of the system.

14 October 2010

hundreds of department heads across the organization to obtain needed approvals of new standards. “The guiding principle around our corporate standard was to implement our vision and approach through formal policies coordinated with all stakeholders,” says Whitesel. “The committees we established provided structure and integrity around that process and opened up the lines of communication between all who were involved. The governance structure also created a sense of shared ownership around the standards, which was critical for driving support and compliance.” With formal processes in place, Bon Secours cre- ated an overview of the standardization project and then built a work plan, which involved examining each clinical area, looking “under the hood” of each facility and comparing facilities by department to identify best practices. The system tackled charge methodology fi rst, next turned its focus to charge structure, and then developed standards and pricing policies across the organization. Among the results, the team identifi ed several million dollars in charges that weren’t being captured previously.

Once the standard was in place, Bon Secours has continued maintaining its coding integrity through its CDM solution. Gap analysis can be completed at the hospital level for each facility, letting executives know when a coding rule is not followed. They also use their standardized CDM solution similar to a central data- base, always referring to the up-to-date, organization- wide coding information.

Extending the reach

Bon Secours didn’t just stop with the corporate stan- dardization initiative. The organization also leveraged this opportunity to put in place additional enterprise- wide best processes, including an enterprise billing system and integrated claims and charge capture audits solutions, for which corporate standardization had laid a strong foundation.

A key solution for helping Bon Secours capture all revenue from supply charges and maintain its corpo- rate enterprise standards is Charge Capture Audit, a revenue optimization solution from MedAssets. CCA applies rules to pre-bill data as it reviews 100 percent of patients’ itemized bills and then fl ags potential missed charges so errors can be corrected before bills are sent. Several years ago, after successfully implementing CCA with impressive results at one facility, Bon Secours elected to use the solution throughout its entire sys- tem, which it can now do thanks to enterprise-wide standards. For best practice claims management, Bon Secours utilizes XClaim to automate and manage the organiza- tion’s claims process. In addition to extensive claims ed-

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