Journal of the Association of Healthcare Internal Auditors, Inc. Journal of the Association of Healthcare Internal Auditors, Inc.

FEATURE

IASIS Healthcare: Implementing A Corporate Chargemaster Solution

Art Bell

IASIS Healthcare is based in to facilities for implementation of Craneware’s ACMPT, OSI’s BPI.Net, and Tennessee and consists of a 14 recommended changes.Many of the MedChex. Each product was carefully acute care hospital system plus following problems, typical of this reviewed and tested against the desired a behavioral health hospital, two manual approach, resulted: staff found objectives and reference sites were ambulatory surgery centers and a the CDM management time-consuming, checked. Finally, Craneware’s ACMPT physician practice management arm. information was hard to source, and product was chosen as the best product Its facilities are spread across Arizona, CDM management was reactive rather for IASIS’s needs. Florida, Texas and Utah. IASIS began than pro-active. Logistically, a nightmare a standardization project across many perspective ensued for people trying to Why A Corporate Standard CDM? of their applications and processes manage standardization and compliance in 2002, and quickly identifi ed with regulatory requirements across the CDM management was quickly Chargemaster management as a key system. identifi ed as a key component due to the area of the project. The following It was clear that a better approach huge reimbursement and compliance paragraphs describe their process for was needed. With the advent of the implications across IASIS’s various identifying and implementing a solution Ambulatory Payment Classification facilities. IASIS saw the development of to address their aims for improving the System, CDM management was a Standard Corporate CDM as the best management of their Chargemaster becoming an increasingly vital way to manage and maintain appropriate fi les across the hospital system. component in the reimbursement and reimbursement levels and regulatory compliance arena. CDM standardization compliance. Mapping individual facility Identifying Issues And Solutions across facilities and cost reduction were CDM’s to the Corporate Standard would desired outcomes. The Corporate team ensure consistency across the system Two years ago, IASIS was a quickly realized that an automated and limit the number of personnel and typical hospital system when it came tool, allowing them to standardize and hours involved in CDM management as to their approach for managing the centrally control the CDM’s for individual a whole. The team also recognized that Charge Description Master (CDM) facilities, was the way to move forward although descriptions, CPT /HCPCS, and fi les throughout their hospitals. Each and meet objectives. Revenue codes would be standardized facility was responsible for maintaining This decided, the team set about across the board, pricing would remain their own CDM, and this process sourcing solutions that would help them independent and set by each facility was all handled manually, meaning meet their objectives. Various vendors based upon the individual market. that individuals were responsible for were contacted with the following reviewing each line item to check the objectives sought: ease of system use, Implementation accuracy of the coding, description, automated CDM reviews, online access charging, etc. Occasionally, consultants to reference tools, and both on and off- With the Corporate Standard plan would be invited in to review the CDM line usage. in place, and the software to create fi les, and this would result in the standard IASIS finally reviewed three it chosen, IASIS had to identify a way pile of reports then being forwarded companies and their software products; of bringing their plans to fruition.

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Two main options were available for address facility specifi c questions, change has brought about an improved beginning the process. The Corporate and bring any issues to the attention process. An added benefi t has been FEATURE team could immediately begin to create of the corporate team. Service the improved communication among the Corporate CDM by mapping the Specifi c specialists were also drafted the facilities, with the corporate teams individual facilities fi les in their current into the team to address particular as mediators. ‘non-reviewed’ state, or they could use departments. Once all phases are The Emergency department the software to clean up the individual completed, the individual CDM’s will was selected as the first facility CDM’s before creating a standard continue to be managed centrally by the department due to the potential using the ‘clean or reviewed’ fi les. Corporate Team. reimbursement exposure under the IASIS chose the second option of Medicare APC reimbursement system. cleaning up the individual CDM’s using Timescales As a result of the cleansing and the software fi rst, and then moving to standardization of that one area, the creating a standard. The benefi ts of this IASIS had the ACMPT software business offi ce has experienced a 50% choice included easier standardization installed in their fi rst facility in April increase in cleaner claims, corporate across facilities, the ongoing production 2003, with the rollout to their other compliance has reached a 100% of cleaner claims, more timely facilities taking place over the following confi dence level with billing practices, reimbursement collection, and enabled couple of months. The plan is to have and reimbursement has increased IASIS to achieve the best results in the all facilities corrected and clean, the 25% over last year. Similar results are quickest timeframe. The Corporation Corporate Standard created, and the expected from other departments. The was also less likely to fall foul of any of facilities all mapped by December 31st , standardization process is designed to the Compliance regulations. In short, 2004. bring corporate confidence in it was believed that this approach The team is currently in the process compliance to the 100% level within all would give them a quicker Return on of cleaning up CDM fi les and building departments. ! Investment on the software purchase. the Corporate Standard; the process Once all IASIS’s facility CDM’s are of mapping facilities to the standard Art Bell is the Director of HIM cleaned, the organization will move has not yet begun. The cleaning Operations/CDM Compliance and to create a Corporate Standard by and standardization processes have Billing Compliance Offi cer at IASIS selecting ‘Best Practice’ departments been approached on a departmental Healthcare. Printed with permission. from across the various hospitals. All basis, as this was most logical given facilities will then be mapped to the that standardization was equally as Corporate CDM, thus ensuring that important as cleaning up data. The revenue will remain neutral or increase. Emergency Department was the fi rst An education plan has been put in place targeted and has now been completed. to ensure that all departments and The process is ongoing in the Operating facilities understand the changes being Room, Anesthesia, Post Anesthesia made, and that processes are defi ned Care Unit, Therapies, Pharmacy and to ensure the CDM is being correctly Central Supply. The processes are also utilized. taking into account the need to remain revenue neutral; this means the re- The Team basing of charges for services, taking into account the changes in charge IASIS decided to manage the “clean processes at each individual facility. up”, standardization, and mapping Extensive research and calculations are processes of their facility fi les centrally required to accomplish this time- within the Corporate team. This consuming task. decision was taken to help counteract the tight timescales involved in the Benefi ts operation, and the inconsistent levels of CDM knowledge across the facilities. A The IASIS Corporation is already team of three people was established at reaping the benefi ts of the CDM the corporate level to manage the whole Standardization Project. This has been process. This team was supplemented refl ected by cleaner claims, improved by a CDM coordinator at each facility to reimbursement and compliance encourage departmental involvement, levels, and cleaner cash fl ows. Each

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