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Managing a hospital’s chargemaster — where every service the hospital gets paid for is listed — is a patient financial services job that is rule-oriented, fraught with compliance challenges, and "full of bear traps," says Jack Duffy, FHFMA, director and founder of Integrated Revenue Management (IRM), Carlsbad, CA. But despite extensive research, Duffy notes, he found no training program in the entire country that prepares an individual to be competent in that area. That will change in July, he says, with the introduction of the Chargemaster Institute of America, an enterprise that will be a business partner with IRM.
That situation can be looked at as a microcosm of the state of the art of training in the world of health care revenue management, Duffy suggests. "You can get in so much trouble, so fast, with [inadequate management of] the chargemaster. Every dollar of revenue goes through it," he adds. "In the future, every account will be scrutinized by the Health Care Financing Administration [HCFA], and the intersection between the contract and the chargemaster will determine the success of hospitals."
After interviewing a man who worked for a 932-bed hospital that was a potential IRM client, Duffy notes, he discovered that although the individual had responsibility for the chargemaster, he spent only 20% of his job time on that task. Considering that the organization’s chargemaster included 72,000 items, Duffy adds, "We said, How can you be effective?’ He said, I really can’t.’ We asked, How were you trained?’ He said, I wasn’t.’ He was very bright, but he had no support, and limited time compared to his responsibilities."
To date, Duffy points out, a hospital’s option for cleaning up its chargemaster and bringing it up to date and into compliance has been to hire a consulting firm, which in turn recruits a coder. "That coder will come in and test the chargemaster against some kind of standard [and bring it up to speed]. The fee for that will be $100,000, and on the day they finish, the chargemaster become obsolete."
The Chargemaster Institute’s approach, in contrast, will be to train a person from the hospital — during a three-week intensive in Carlsbad — on the sophisticated software associated with the chargemaster, he says. As part of the training, that individual will bring the chargemaster up to the industry standard, and will learn how to keep it up to standard, Duffy adds.
The new CPT (common procedure terminology) codes are published annually, he notes, and all graduates of the Chargemaster Institute will come together to install those codes for their organizations. The cost for the entire training cycle will be $19,500, Duffy says.
"These people [who work with chargemasters] are islands of information," he notes. "There is no professional organization that supports that. Some of what they do will be very routine — add a new code, make a procedure change. Some of it will be highly sophisticated, where you get into multi-tiered discussions with HCFA, [as in], The physician wants to do this. How do I do it?’ You can find a new opportunity at every turn."