Chargemaster and APC Articles and Worksheet

APCs affect all outpatient services under Medicare payment.

One of the critical areas of organizational systems involvement for APC success is validation of code selection and reimbursement data that affect APC groups.

When selecting an APC Coordinator, it is important to select someone with knowledge and expertise of billing systems and clinical departments as well as the HIM department.

One of the responsibilities for the APC coordinator would be to analyze information flows for the billing process.

The APC team is best organized as a subcommittee of the facility's medical record committee.

In assessing the revenue cycle, it is important to map the information flow through the organization's automated information systems to assure the timeliness of information transfer.

It is important to perform an in-depth review of chargemaster detail because 100% of charges associated with ambulatory surgery are generated through the chargemaster.

The APC Team should include representation from HIM, information systems, nursing in ambulatory surgery and ancillary areas, patient finance/patient accounts, registration, and administration among others.

It is important to develop a system where HCPCS codes must be matched to the appropriate revenue codes because revenue codes drive the packaging in the APC system.

The primary objective of the APC system is to control costs for Medicare beneficiaries.

Placement of the APC grouper in the organization's information system must be analyzed because unlike the DRG system, the APC system uses both chargemaster-assigned and coder-assigned procedures in the final grouping process.

One of the steps in examining the documentation processes is to review the information systems that generate supporting documentation for charges included on the HCFA 1500.

The charge master is also known as a master charge list or a charge description list.

The various supplies listed on the charge master for the average facility drives reimbursement for approximately 50% of the UB-92 claims for outpatient services alone.

An inaccurate charge master may result in overpayment, underpayment, undercharging, claims rejection, fines and/or penalties.

Because the charge master is an automated process that results in billing numerous services for high volume patients, there is a risk that a single coding or mapping error could spawn many billing errors before it is identified and corrected.

One of the key elements of the charge master is the "Procedure Description" which has a set format and vocabulary used by all facilities.

One of the required fields in the charge master is the ICD-9 procedure code.

The "Revenue Code" is a two-digit code number representing a specific accommodation, ancillary service, or billing calculation required for Medicare billing.

The "Charge Dollar Amount" is the specific amount the facility will be reimbursed by a third-party payer.

The charge master should be overseen by a committee composed of key facility representatives that will contribute to the accuracy and quality of both the document database and the charge master review process.

All services and procedures listed on the charge master will have a CPT or HCPCS code.

The charge master committee should include representatives from health information management, ancillary departments, the financial service/business office and information systems.

One of the responsibilities of the charge master committee is to review CPT codes, procedure and service descriptions, and revenue codes for accuracy.

Any application that involves one charge description number "exploding" into more than one CPT/HCPCS code should be reviewed to prevent inadvertent unbundling or unearned reimbursement.