When Kathy Huston began searching for a new hospital chargemaster maintenance tool, she knew she wanted software that would be easy for the hospital staff at Hendrick Medical Center to use for coding and billing.
But Huston, charge capture coordinator at Hendrick, found a hospital chargemaster maintenance tool that gave the hospital staff more than ease of use: It also provided coding and billing analysis.
The ability to perform that kind of analysis makes the health system more efficient, Huston said. While a full chargemaster does contain a vast list of pricing information and billable items, one source said it's not an efficient price comparison tool for patients -- something the federal government is pushing.
Identifying billing inaccuracies
Hendrick opted for a hospital chargemaster maintenance tool from VitalWare, a revenue cycle management software vendor. Hendrick uses the hospital chargemaster maintenance tool, which has been in place for about a year, to manage anything a patient could be charged for -- from supplies and drugs to procedures and surgeries, she said.
The VitalWare hospital chargemaster maintenance tool offers the hospital staff a simplified workflow, compiling information into one window for the health system's roughly 60 chargemaster users, rather than forcing them to jump around to different windows -- an issue the health system struggled with while using a former chargemaster product.
"When they would click on a hyperlink, it would take them off to a totally different window," Huston said. "This one, everything is on one screen, separated by tabs, and you just click on the tabs and go directly to the information you're looking for. Everything is visually right there in front of you."
The maintenance tool also ensures the health system stays up to date with regulatory requirements for coding and submission on billing and pricing to insurance providers.
The VitalWare hospital chargemaster maintenance tool, which ranked highest in the 2019 Best in KLAS report for the revenue cycle, chargemaster management category, identifies discrepancies in coding and pricing, Huston said. That's the same reason Colleen Malmgren, director of revenue integrity for Fairview Health Services in Minneapolis, opted to invest in the product.
Colleen Malmgrendirector of revenue integrity, Fairview Health Services
"It's the things that you don't notice that I think can really add up quickly," Malmgren said. "I think having chargemaster software that gives you edits and tells you about potential things that are missing or inaccurate is very important."
Malmgren said, because the VitalWare hospital chargemaster maintenance tool analyzes coding and billing, she's noticed less billing inaccuracies and missing information as department heads submit billing information. The software picks up on inaccuracies that would otherwise go unnoticed and result in payer denials, she said.
Malmgren said the VitalWare hospital chargemaster maintenance tool provides immediate updates and makes the workflow more efficient through its ease of use. She added that it has helped reduce the health system IT staff's workload.
In the past, Malmgren's team used a product that required more work from IT. The chargemaster, which is always in flux, used to be located on an internal server, and updates became a time sink, she said. The VitalWare hospital chargemaster maintenance tool is cloud-based and updates automatically.
CMS requires hospitals to publish chargemaster data
In a push for price transparency, CMS requires that hospitals publish their chargemaster data -- a regulation that went into effect Jan. 1.
It is a move Ge Bai, associate professor at Johns Hopkins Carey Business School, said is a "step in the right direction" for price transparency, but she doesn't think it goes far enough. She said she believes CMS needs to make changes to the resolution, if the agency wants to make price transparency more effective.
The resolution aims to increase patient price comparison, which would, in turn, lead to a more competitive healthcare market. But Bai said the chargemaster includes vast amounts of price information, far too much for the average patient to sift through. Additionally, most insured patients don't end up paying the actual chargemaster price and pay a lower price negotiated for them by their insurance providers.
A more effective approach would be to require hospitals to release chargemaster information for the most common procedures to make it easier for patients looking to compare prices, she said.
"The usefulness of this resolution is limited," she said. "This is a bookkeeping tool, not something designed for price comparison."