 |
 Has
Your Laboratory Chargemaster Had Its Annual Checkup?
The laboratory Chargemaster is an often neglected document, when
in fact the Chargemaster is the very foundation upon which all other
statistical files are built. Many occurrences over a year's time
will affect the validity of the Chargemaster CPT coding, rendering
an annual review by technically versed individuals imperative. Adjustments
to the Chargemaster are dictated by the annual AMA changes to the
CPT coding (this is generally published in November) for the succeeding
year, incorporation of new tests to the laboratory menu (both testing
performed on-site and those requests referred off-site), new or changing
test methodologies and/or equipment and pricing adjustments.
Chi Laboratory Systems has performed over 100 Chargemaster reviews
and estimates that 90% of the client files reviewed failed to contain
the CPT codes necessary to bill all tests performed. The omission
errors generally include failure to properly link the LIS and HIS,
the use of deleted CPT codes, failure to fully explode panels to
their individual components (especially for reference testing),
and errors in histopathology, flow cytometry and microbiology coding.
These omissions when corrected generally yield outpatient/outreach
reimbursement from various payors of $4,000 — $125,000 (average
of $25,000 — $50,000) based on differing testing volumes.
The necessity to maintain a correct Chargemaster impacts all areas
of the laboratory and various hospital departments as well. The CPT
code is the common denominator in many studies and performance indicators
and serves as the basis for many functions, including:
| 1. |
Compliance – Correct CPT coding is the responsibility
of the provider of the diagnostic service and defines and impacts
Medicare billing. |
| 2. |
Operations – Assessments, performance and
scenario assumptions are driven by the CPT code assigned to the
various test descriptions – these affect all productivity
and cost per test studies. |
| 3. |
Benchmarking – Benchmark assessments of a
laboratory and subsequent performance profiling are driven by
the revenue and usage files of the laboratory. These are directly
linked to the test description and CPT code employed in the Chargemaster. |
| 4. |
Cost Analysis – Revenue and usage files, RVUs
and costing systems are defined by the CPT code and descriptions
of the various laboratory tests. |
| 5. |
Marketing – The CPT code is used for baseline
assessments, sales forecasts and projections, and outreach revenue
projections. The correctness of these codes affects the revenue
stream analyses. |
| 6. |
Billing – The billing department relies upon
a correct interface between the LIS and HIS to yield the CPT
codes appropriate to the tests performed and reported. It is
imperative that the CPT or HCPCS code that is used to bill accurately
describes the service that was ordered and performed. |
| 7. |
Medical Records – The ICD-9 and CPT codes
are the basis for coding functions. |
| 8. |
Administration – The CPT code is what drives
all laboratory statistical reports in addition to test utilization
parameters. |
An annual Chargemaster review by a knowledgeable source is a sound investment
for both the laboratory and the hospital statistical database. It ensures
correct reimbursements, compliance and sound administrative baseline
data from which to make decisions, projections and scenario assumptions.
Kathleen Cross, MT (ASCP), is a registered medical technologist
consulting in laboratory operations and compliance for Chi Laboratory
Systems, Inc. (CLS).
Chi Laboratory Systems CLS is a
Park City Solutions company offering a comprehensive list of consulting services.
The CLS compliance group has performed over 100 laboratory Chargemaster reviews.
For more on this topic, visit Chi Lab's CDM
CPT Code Analysis Program Overview.
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