Tara Gillon – Importance of Performing an Annual Chargemaster Analysis | This Week in Surgery Centers
Here’s what to expect on this week’s episode. 🎙️
When was the last time you reviewed your chargemaster? If the answer isn’t “within the last 12 months,” the odds are high you’re leaving easy money on the table and underbilling.
Tara Gillon is the Chief Operating Officer at Serbin Medical Billing. She joins our host Nick Latz on this week’s episode to discuss the Importance of Performing an Annual Chargemaster Analysis. Here are a few highlights.
• There are several ways to develop your chargemaster, but most will build it based on a percentage of Medicare’s reimbursement.
• While the recommendation is to review your chargemaster annually, the reality is most ASCs rarely update theirs, which is a practice we want to move away from.
• You can perform the analysis yourself using a tool that is as simple (and free!) as Microsoft Excel or Google Sheets. After setting your sheet up once, the analysis only takes 5-10 minutes.
• Knowing your contracts inside and out is critical, as there might be increase limitations and other requirements.
Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details!
Episode Transcript
0:00
welcome to this week in surgery centers
0:03
if you’re in the ASC industry then
0:06
you’re in the right place every week
0:08
we’ll start the episode off by sharing
0:10
an interesting conversation we had with
0:11
our featured guests and then we’ll close
0:13
the episode by recapping the latest news
0:15
impacting surgery centers we’re excited
0:18
to share with you what we have so let’s
0:20
get started and see what the industry’s
0:22
been up to
0:23
[Music]
0:27
hi everyone here’s what you can expect
0:29
on today’s episode Tara Gillen is the
0:33
chief operating officer at serbin
0:35
medical billing and she joins our host
0:37
nicoletts to talk all about the
0:39
importance of performing an annual
0:41
charge Master analysis we’ll dive into
0:44
what role the charge Master plays why
0:46
it’s so important to compare your
0:48
current charges against your Managed
0:50
Care contracts and how to get started
0:52
with the analysis as a whole
0:54
and then in our news recap we’ll cover
0:57
the good work Blue Cross North Carolina
0:59
is doing HIPAA complaints patient
1:02
engagement technology and of course and
1:04
the new segment with a positive story
1:06
about the history being made at the
1:08
University of California San Francisco
1:10
hope everyone enjoys the episode and
1:13
here’s what’s going on this week in
1:15
surgery centers
1:17
good night
1:20
Tara welcome to the show
1:22
thanks so much for inviting me it’s a
1:24
pleasure speaking with you appreciate
1:26
you joining us and let’s let’s jump
1:29
right into the topic at hand Tara given
1:31
your expertise with Urban medical I
1:33
thought it’d be good today and
1:34
interesting for our listeners to talk
1:36
about the revenue cycle and specifically
1:38
hone in on the charge Master uh today
1:42
and and you know the charge Master
1:44
analysis exercise in particular to start
1:46
you just give us a little overview of
1:48
the charge master and the role it plays
1:50
within the revenue cycle within an ASC
1:52
setting
1:54
absolutely so the charge Master is a
1:58
list of the centers fees for the
1:59
services they provide
2:01
so this is a listing of the separate
2:04
charges that the ASC has developed for
2:07
every procedure Supply and service that
2:10
they will perform there are many ways to
2:12
develop a charge master and there’s no
2:15
one-way or wrong way
2:17
in developing a charge master
2:20
um most ASCS will create their first
2:23
initial charge Master using a percentage
2:26
of Medicare reimbursement this is
2:28
because
2:29
the Medicare fees are published and
2:31
easily found and new surgery Centers do
2:34
not typically have built-in Managed Care
2:37
fee schedules to compare to at that time
2:40
an example of this would be you may see
2:43
a brand new Surgery Center use a
2:45
multiplier of three to four times
2:47
Medicare to establish their charges
2:50
when using Medicare as your base in
2:53
building a charge Master there’s a few
2:55
things that ASCS need to keep in mind
2:59
one is being the type of specialty or
3:03
procedures that the ASC will perform
3:06
you have to understand Medicare is not
3:08
an all-inclusive list and depending on
3:11
the type of services the ASC may find
3:13
many of their procedures that they plan
3:15
on performing not covered on the
3:18
Medicare fee schedule for examples those
3:20
ASDS that plan to offer you know pain
3:23
management spine for heavy Orthopedic
3:26
May encounter this more than let’s say
3:28
in higher General Surgery Center
3:31
um for those procedures that are not
3:33
covered on Medicare the ASC will still
3:36
need to develop a charge
3:38
the reason is just because it’s not
3:39
covered under Medicare does not mean
3:41
that it other payers will not cover the
3:43
procedure or that it can’t be performed
3:47
um you can do this simply by looking at
3:48
your market area to determine the fee
3:50
doing a little bit of research in that
3:53
um the second
3:55
item to be wary to understand is the
3:58
facility’s use of implants
4:01
Medicare does not pay separately for
4:03
implants
4:05
they do however have a number of set
4:07
procedures that they consider device
4:09
intensive this means that Medicare has
4:12
rolled in the cost of the implant to
4:13
proceed your fee
4:15
if the ASC does a straight multiplier of
4:18
the Medicare fee schedule including the
4:20
device intensive codes
4:22
the ASC may see charges that look
4:24
extraordinarily high or higher than what
4:27
they anticipated
4:29
as Medicare rolled in that implant into
4:32
that procedure cost so you may want to
4:33
consider taking the device portion out
4:36
of the multiplier
4:37
and just using the procedure portion if
4:40
you’re a center that’s going to be heavy
4:42
on implants When likely your other
4:44
payers
4:45
your contracts are going to include cost
4:47
of implant anyways
4:49
um as a separate reimbursable item
4:53
the third is always set a minimum fee
4:56
once you run your multiplier bump any
4:58
feed that is under your minimum up to
5:01
that minimum
5:03
um that’s the main way that most brand
5:06
new surgery centers will develop a
5:07
charge master
5:09
the other common way to develop a charge
5:11
Master is if your existing Surgery
5:14
Center or if you are um or if you have
5:17
access to Managed Care contracts maybe
5:19
through your joint venture or something
5:21
along those lines
5:24
um you’ll run a comparison of those
5:25
Managed Care contract fees
5:28
finding your the highest reimbursable
5:31
and building your charge Master off of
5:33
that so for instance you may do like one
5:35
and a half two times your Blue Cross
5:36
Blue Shield
5:38
to build your charge Master but you
5:40
still want to
5:41
set the minimum fee
5:44
um and bump things up to them yeah that
5:47
makes sense and you you mentioned that
5:48
ASC is typically you know have to
5:51
develop their charge Master when they
5:53
start billing right when when they open
5:55
their doors and first start seeing
5:57
patients I want to get your experience
5:59
and advice here on how often does this
6:02
charge Master get Revisited and updated
6:06
well
6:08
based on my experience
6:11
um it rarely does on what you should do
6:13
you should review it annually okay
6:17
um so the reason why is
6:21
um
6:22
you know your contracts are going to
6:24
change depending on how your managed
6:26
contracts are negotiated
6:29
um they have the possibility of changing
6:31
annually as well so for instance if you
6:34
have managed care contracts that are
6:36
based off of a percentage of Medicare
6:38
meaning that they’re going to pay 160
6:40
percent of Medicare or 210 percent of
6:43
Medicare
6:44
whatever that percentage may be
6:47
Medicare updates annually yep so
6:51
therefore your negotiated rate is going
6:54
to update annually
6:56
um or you have managed care contracts
6:58
that are based on a grouper rate
7:00
you may have built-in escalators into
7:02
your contract meaning that every year
7:05
your group of rates increase by three
7:08
percent
7:10
or so forth for a period of times and
7:13
every year there are new codes that are
7:15
added
7:18
um to where the payers go through and
7:20
they reclassify code so groupers may
7:22
change throughout the year
7:25
um so it’s a good idea to review and
7:28
analyze your charge master
7:30
because what you will find is if you’re
7:32
not doing that analysis on an annual
7:34
basis you may eventually find yourself
7:38
under billing
7:39
not getting the reimbursement that you
7:42
expected
7:44
um are deserved in an ASC yeah it makes
7:48
sense and from a business impact and
7:50
revenue impact perspective
7:53
it certainly makes sense to me that we
7:55
don’t we don’t want to under Bill and so
7:57
you know it would be good practice for
7:59
Center to do this on an annual basis can
8:01
you walk me through you know the
8:03
recommended process you’d recommend to
8:05
an ASC that wants to do an annual review
8:07
of their charge master
8:09
absolutely so typically you know I’m I
8:14
love Excel and Excel is my best friend
8:16
so I didn’t know my analysis on Excel
8:20
um so I usually keep for all of the
8:22
clients that I do an analysis for
8:24
um I have all of the fee schedules on
8:27
one Excel sheet for that client
8:30
um that includes you know your Medicare
8:32
your workers comp your Managed Care
8:34
contracts Etc any
8:37
payer that I have a set fee schedule for
8:39
I have it loaded on one Excel document
8:42
yep and columns and then I have my
8:44
charge Master on there as well
8:46
I’m going to have Excel
8:50
um pull out my highest fee
8:52
for every procedure that that client
8:55
does
8:57
going to analyze that against my charges
9:00
and I’m going to make sure that the
9:01
charges if they are under the highest
9:04
fee then that tells me that I need to up
9:08
and do a charge Master increase
9:11
that’s the quickest and simplest way
9:14
to do it it takes minutes if you’ve
9:18
already prepped your Excel document and
9:21
done your loaded your fee schedules in
9:25
um what you have to consider before you
9:27
do a charge Master increase
9:29
is that you need to really know your
9:32
contracts because there are payers payer
9:35
contracts that may have limitations into
9:38
increases built into their contracts so
9:40
they may limit you on a percentage that
9:43
you can increase
9:45
they may limit to you on
9:47
time frames that you can increase
9:50
maybe saying you can only increase every
9:51
two years or so forth and they may also
9:54
have guidelines as to Notifications
9:56
required for your intent to increase
10:01
um so really know your payer contracts
10:05
before you go jump into this and do an
10:08
over an overall increase
10:12
um so there’s sounds like there’s Nuance
10:14
in in these in these contracts and you
10:17
and you really got to get into the
10:18
detail are there other pitfalls
10:23
yeah so
10:24
really the
10:27
other thing you want to consider is as
10:29
you’re increasing these charges is you
10:32
want to
10:34
you wanna you definitely want to
10:36
increase them higher than your highest
10:38
negotiated fee
10:40
but you also don’t want to increase them
10:42
so high that your adjustments are
10:44
through the roof
10:46
give yourself a reasonable cushion
10:49
if you know that your contracts are
10:52
mostly based off of Medicare and it’s
10:54
going to be a annual update
10:58
you may want to give your cushion enough
11:01
to where you don’t have to increase it
11:02
every year that your cushion is still
11:05
going to support those changes with
11:07
those contracts on a yearly basis
11:10
but don’t do it so high to where your
11:13
adjustments are
11:15
just through the roof
11:17
um
11:18
that’s extremely important if an ASC
11:21
decides to do contractual adjustments at
11:23
payment posting instead of at billing
11:26
because their AR will always reflect
11:28
that growth which is not an accurate
11:30
representation of what they expect to
11:32
come in
11:34
because the adjustments are not
11:35
calculated in so
11:39
there are a couple nuances you have to
11:42
consider when you are doing these charge
11:44
Master reviews
11:46
got it that that makes sense
11:49
um
11:50
in terms of the implications sounds like
11:52
your your recommendation is to do this
11:54
on an annual basis from an implication
11:56
standpoint for folks that that don’t do
11:58
it that often you mentioned under
12:00
billing
12:01
because things things can change are
12:04
there any other major implications that
12:06
folks need to keep in mind yeah yeah so
12:08
the implications really are you know
12:11
like you said the under billing
12:14
um
12:15
there are you know for example the
12:18
actually the biggest indicator that a
12:21
surgery center needs to review their
12:24
charge Master is when they start seeing
12:26
payers pay a hundred percent of their
12:28
bill charge
12:30
I know that sounds great in theory
12:33
but what that means is is that the payer
12:35
doesn’t have to take any adjustment
12:37
because you are under billing their
12:39
allowance
12:41
so for instance if your contract says
12:44
that Sigma for a knee procedure needs to
12:46
pay you five thousand dollars but your
12:49
charge is only 3 500.
12:53
Cigna technically off they have to pay
12:55
you is 3 500. because that’s what you
12:58
build them
13:00
so you really don’t want to see that 100
13:02
of Bill charge
13:05
on these negotiated payers that’s a big
13:07
indicator
13:09
what this analysis is going to show you
13:12
is not only
13:13
you’re under billing but let’s say that
13:16
you have carve outs negotiated with
13:18
let’s say Aetna and for a certain
13:21
procedure you’ve negotiated eleven
13:23
thousand dollars with Aetna and this
13:25
charge master in this contract was
13:28
created at the time ASC opened and it’s
13:30
been years it’s never been updated or so
13:33
forth
13:34
you did the initial analysis and
13:36
negotiation based off that Medicare
13:38
didn’t pay for the procedure or that
13:40
Medicare paid a certain amount for it or
13:42
so forth and now based off of all the
13:44
CMS changes and new codes coming in and
13:47
allow procedures Medicare now pays 11
13:49
500.
13:53
this is going to give you tools to be
13:55
able to go back to those payers and
13:57
renegotiate better rates so fantastic
14:01
and so this seems like low-hanging fruit
14:03
Tiara in terms of hey let’s make sure
14:05
you know every year on an annual basis
14:07
we’re going through and making sure
14:08
we’re not leaving dollars on the table
14:10
from a revenue perspective but ASE
14:13
administrators are busy business
14:15
managers are busy
14:17
for ases that need help with with the
14:20
process like this what would you
14:22
recommend who who what types of
14:24
companies and resources are available to
14:25
help
14:26
you know the companies that are
14:28
available to help are you know there are
14:30
revenue cycle management companies such
14:32
as you know serving medical billing
14:34
which is who I work for
14:36
um there are
14:37
um you know
14:38
Managed Care
14:40
um
14:41
management companies
14:44
um other than that there’s simple Excel
14:48
tutorials that can make this process
14:50
five ten minutes
14:54
um this doesn’t have to be a long
14:56
process to that will take all day
15:01
um and so forth it is a very simple
15:04
process once you know how to plug the
15:07
formulas into Excel and IT pretty much
15:10
does all the work for you
15:12
fantastic
15:13
um and you mentioned RCM companies can
15:15
can help with services like this and
15:17
kind of within the RCM
15:19
provider Sweet Spot can you tell us just
15:22
a little bit about Serb in medical and
15:24
specifically kind of how you guys
15:26
position your services within the
15:28
overall ASE RCM space sure so serpent
15:33
medical billing we are a we kind of
15:36
build ourselves as a concierge
15:40
um ASD billing and revenue cycle service
15:43
we offer a very personalized package to
15:46
our clients it goes beyond just coding
15:48
and billing for the ASC
15:51
um we act as an extension of their
15:53
business office
15:55
and assist in navigating various hurdles
15:58
such as charge Master analysis
16:00
um
16:01
that the ASE May encounter in the
16:03
revenue cycle process
16:05
um
16:06
so we we kind of look at ourselves as
16:09
partners with the ASC
16:11
to um offer those unique and
16:13
personalized services
16:16
fantastic
16:18
and last question for you here today
16:20
Tara we do this every week with our
16:21
guests what is one thing our listeners
16:23
can do this week to improve their
16:25
surgery centers
16:27
charge master and
16:29
[Music]
16:31
um it really is truly a very simple
16:33
process to do
16:36
um I know it sounds scary and it sounds
16:38
big but it truly is not
16:41
um and it will really
16:43
had your facility into the right path
16:45
for 2023
16:47
um to get that information that you need
16:50
and like you said it’s low hanging fruit
16:51
but it’s quick low hanging fruit
16:54
that’s the kind of looking fruit we like
16:56
the best Tara thanks so much for joining
16:58
us today appreciate it
17:03
[Music]
17:06
as always it has been a busy week in
17:08
healthcare so let’s jump right in our
17:11
first story comes from Med City News and
17:14
they’re sharing some heartwarming news
17:15
from Blue Cross North Carolina
17:18
due to fewer employees working on site
17:20
their cafeteria is seeing less and less
17:23
activity and remains relatively empty
17:27
so they saw this as an opportunity and
17:30
decided to use the cafeteria to prepare
17:32
meals and then distribute them to more
17:35
than a dozen non-profits in the area
17:37
which then provide the meals to those in
17:39
need to their communities
17:41
North Carolina actually has 1.6 million
17:44
households that don’t have enough food
17:46
so their work will make a huge
17:49
difference to this community
17:52
um and the payer’s on-site meal delivery
17:55
program has already shared some
17:57
impressive numbers about 3 400 meals
18:00
were distributed in January and they
18:03
hope to distribute another 4 200 in
18:06
February
18:07
um now what started off as a temporary
18:09
winter program that’s kind of what they
18:11
called it
18:12
um you know it was only supposed to run
18:14
for three months and it is still set to
18:16
end on March 31st but they’re thinking
18:18
they might continue on long term they’re
18:21
currently evaluating if it’s something
18:22
that they can continue with and I think
18:25
we can all hope that they do according
18:28
to an article from Healthcare dive the
18:30
HHS office for civil rights or OCR
18:33
receives 39 more HIPAA complaints in
18:37
2021 than they did from 2017. and large
18:41
breaches affecting 500 people or more
18:43
increased 58 in that same time period
18:47
this information was shared in the
18:49
agency’s annual report to Congress along
18:52
with the unfortunate reality that while
18:54
complaints have increased within that
18:56
four-year time period the Staffing and
18:59
resources have not which is obviously
19:01
causing a severe strain on existing
19:03
employees
19:05
um the article did share a few examples
19:07
of investiga Investigations that the OCR
19:09
did have the resources to follow up on
19:12
and one that caught my eye was from
19:15
January 2021 when excellus agreed to pay
19:19
5.1 million dollars after an
19:22
investigation revealed poor cyber
19:24
security practices that led to a data
19:27
breach of the PA of Phi of more than 9.3
19:30
million patients
19:33
um so at a time where cyber or security
19:36
attacks on the health care industry are
19:38
becoming more and more common the agency
19:40
that is supposed to be there to help
19:42
protect patients and keep Health Care
19:43
Facilities in line
19:46
um is not properly staffed or funded to
19:49
do so at the volume that is needed so as
19:52
always the moral of the story is to
19:54
invest in your cyber security measures
19:55
educate your staff and just always err
19:59
on the side of caution
20:01
our next story is All About the
20:04
potential of Technology when it comes to
20:06
patient patient engagement and the
20:08
patient experience
20:11
um the Ohio gastroenterology group was
20:14
averaging about 50 000 phone calls per
20:17
month from patients and it became nearly
20:19
impossible for them to handle patients
20:22
were calling for every little thing
20:24
looking for information on time you know
20:27
the address parking clinical concerns
20:30
and and anything else that came up they
20:32
had nowhere else no way else to reach
20:34
out to them except for picking up the
20:36
phone so they really needed a solution
20:38
to overcome this huge time suck and it
20:41
was also causing patient dissatisfaction
20:43
because they couldn’t get a hold of
20:45
anyone and had to leave voicemails and
20:47
it just wasn’t working
20:49
so they decided that they needed a
20:51
change and they decided to roll out a
20:54
few initiatives
20:55
um the first is they plan to gradually
20:58
Implement text messaging email and
21:00
mobile apps to take over that patient
21:03
communication the second is to provide
21:06
richer more helpful information on their
21:08
website so patients I feel like patients
21:11
would prefer most patients to go to a
21:13
website find their own information real
21:15
quick then having to wait on hold and
21:17
leave voicemails and stuff so
21:20
um highly recommend that if you haven’t
21:22
taken a look at your website make sure
21:23
that you’re providing as much helpful
21:25
information as you can
21:27
um but back to the Ohio gastro group
21:29
along the same lines as those the two uh
21:33
initial initiatives that they’re working
21:34
on the third is to implement a smart
21:37
virtual assistant that will be powered
21:39
by conversational AI on their website
21:41
through text and also voice and then
21:44
they’re also working on implementing
21:45
referral scheduling functionality that
21:48
enables patients to book
21:50
um appointments digitally and online
21:52
without having to pick up the phone
21:54
so I highly highly recommend giving this
21:57
article a read what I shared is just
21:59
really the tip of the iceberg of what
22:01
this group is doing and it actually
22:03
really lays out a full action plan of
22:05
how Healthcare groups regardless of
22:07
their size can roll out technology in an
22:10
effective way the reality is if you’re
22:12
not using patient engagement technology
22:14
you’re missing out on a ton of
22:16
Automation and Time Savings on your end
22:19
um and you’re also not providing the
22:20
preferred patient experience so I think
22:24
um you know while it can seem
22:25
overwhelming this article does do a
22:28
great job of showing a very real
22:30
situation
22:32
um where a facility was able to roll out
22:34
patient engagement technology
22:35
successfully
22:38
and to end our new segment on a positive
22:40
note doctors made history at the
22:43
University of California San Francisco
22:45
when for the first time ever a heart
22:47
transplant was performed by an all-women
22:50
medical team a 2019 report found that
22:54
only six percent of adult cardiac
22:56
surgeons in the U.S are women so that’s
22:58
what really made this stand out
23:00
the odds that all seven members of the
23:03
team were women is extremely rare So Dr
23:07
Amy feidler attending cardiac surgeon
23:10
and assistant professor said that it is
23:12
profound to think that by doing our jobs
23:15
we can Inspire women to live what they
23:18
want to do live out their dreams and
23:20
recognize that anything is possible
23:23
and that news story officially wraps up
23:25
this week’s podcast thank you as always
23:27
for spending a few minutes of your week
23:29
with us make sure to subscribe or leave
23:32
a review on whichever platform you’re
23:34
listening from I hope you have a great
23:36
day and we’ll see you again next week
23:40
[Music]
welcome to this week in surgery centers
0:03
if you’re in the ASC industry then
0:06
you’re in the right place every week
0:08
we’ll start the episode off by sharing
0:10
an interesting conversation we had with
0:11
our featured guests and then we’ll close
0:13
the episode by recapping the latest news
0:15
impacting surgery centers we’re excited
0:18
to share with you what we have so let’s
0:20
get started and see what the industry’s
0:22
been up to
0:23
[Music]
0:27
hi everyone here’s what you can expect
0:29
on today’s episode Tara Gillen is the
0:33
chief operating officer at serbin
0:35
medical billing and she joins our host
0:37
nicoletts to talk all about the
0:39
importance of performing an annual
0:41
charge Master analysis we’ll dive into
0:44
what role the charge Master plays why
0:46
it’s so important to compare your
0:48
current charges against your Managed
0:50
Care contracts and how to get started
0:52
with the analysis as a whole
0:54
and then in our news recap we’ll cover
0:57
the good work Blue Cross North Carolina
0:59
is doing HIPAA complaints patient
1:02
engagement technology and of course and
1:04
the new segment with a positive story
1:06
about the history being made at the
1:08
University of California San Francisco
1:10
hope everyone enjoys the episode and
1:13
here’s what’s going on this week in
1:15
surgery centers
1:17
good night
1:20
Tara welcome to the show
1:22
thanks so much for inviting me it’s a
1:24
pleasure speaking with you appreciate
1:26
you joining us and let’s let’s jump
1:29
right into the topic at hand Tara given
1:31
your expertise with Urban medical I
1:33
thought it’d be good today and
1:34
interesting for our listeners to talk
1:36
about the revenue cycle and specifically
1:38
hone in on the charge Master uh today
1:42
and and you know the charge Master
1:44
analysis exercise in particular to start
1:46
you just give us a little overview of
1:48
the charge master and the role it plays
1:50
within the revenue cycle within an ASC
1:52
setting
1:54
absolutely so the charge Master is a
1:58
list of the centers fees for the
1:59
services they provide
2:01
so this is a listing of the separate
2:04
charges that the ASC has developed for
2:07
every procedure Supply and service that
2:10
they will perform there are many ways to
2:12
develop a charge master and there’s no
2:15
one-way or wrong way
2:17
in developing a charge master
2:20
um most ASCS will create their first
2:23
initial charge Master using a percentage
2:26
of Medicare reimbursement this is
2:28
because
2:29
the Medicare fees are published and
2:31
easily found and new surgery Centers do
2:34
not typically have built-in Managed Care
2:37
fee schedules to compare to at that time
2:40
an example of this would be you may see
2:43
a brand new Surgery Center use a
2:45
multiplier of three to four times
2:47
Medicare to establish their charges
2:50
when using Medicare as your base in
2:53
building a charge Master there’s a few
2:55
things that ASCS need to keep in mind
2:59
one is being the type of specialty or
3:03
procedures that the ASC will perform
3:06
you have to understand Medicare is not
3:08
an all-inclusive list and depending on
3:11
the type of services the ASC may find
3:13
many of their procedures that they plan
3:15
on performing not covered on the
3:18
Medicare fee schedule for examples those
3:20
ASDS that plan to offer you know pain
3:23
management spine for heavy Orthopedic
3:26
May encounter this more than let’s say
3:28
in higher General Surgery Center
3:31
um for those procedures that are not
3:33
covered on Medicare the ASC will still
3:36
need to develop a charge
3:38
the reason is just because it’s not
3:39
covered under Medicare does not mean
3:41
that it other payers will not cover the
3:43
procedure or that it can’t be performed
3:47
um you can do this simply by looking at
3:48
your market area to determine the fee
3:50
doing a little bit of research in that
3:53
um the second
3:55
item to be wary to understand is the
3:58
facility’s use of implants
4:01
Medicare does not pay separately for
4:03
implants
4:05
they do however have a number of set
4:07
procedures that they consider device
4:09
intensive this means that Medicare has
4:12
rolled in the cost of the implant to
4:13
proceed your fee
4:15
if the ASC does a straight multiplier of
4:18
the Medicare fee schedule including the
4:20
device intensive codes
4:22
the ASC may see charges that look
4:24
extraordinarily high or higher than what
4:27
they anticipated
4:29
as Medicare rolled in that implant into
4:32
that procedure cost so you may want to
4:33
consider taking the device portion out
4:36
of the multiplier
4:37
and just using the procedure portion if
4:40
you’re a center that’s going to be heavy
4:42
on implants When likely your other
4:44
payers
4:45
your contracts are going to include cost
4:47
of implant anyways
4:49
um as a separate reimbursable item
4:53
the third is always set a minimum fee
4:56
once you run your multiplier bump any
4:58
feed that is under your minimum up to
5:01
that minimum
5:03
um that’s the main way that most brand
5:06
new surgery centers will develop a
5:07
charge master
5:09
the other common way to develop a charge
5:11
Master is if your existing Surgery
5:14
Center or if you are um or if you have
5:17
access to Managed Care contracts maybe
5:19
through your joint venture or something
5:21
along those lines
5:24
um you’ll run a comparison of those
5:25
Managed Care contract fees
5:28
finding your the highest reimbursable
5:31
and building your charge Master off of
5:33
that so for instance you may do like one
5:35
and a half two times your Blue Cross
5:36
Blue Shield
5:38
to build your charge Master but you
5:40
still want to
5:41
set the minimum fee
5:44
um and bump things up to them yeah that
5:47
makes sense and you you mentioned that
5:48
ASC is typically you know have to
5:51
develop their charge Master when they
5:53
start billing right when when they open
5:55
their doors and first start seeing
5:57
patients I want to get your experience
5:59
and advice here on how often does this
6:02
charge Master get Revisited and updated
6:06
well
6:08
based on my experience
6:11
um it rarely does on what you should do
6:13
you should review it annually okay
6:17
um so the reason why is
6:21
um
6:22
you know your contracts are going to
6:24
change depending on how your managed
6:26
contracts are negotiated
6:29
um they have the possibility of changing
6:31
annually as well so for instance if you
6:34
have managed care contracts that are
6:36
based off of a percentage of Medicare
6:38
meaning that they’re going to pay 160
6:40
percent of Medicare or 210 percent of
6:43
Medicare
6:44
whatever that percentage may be
6:47
Medicare updates annually yep so
6:51
therefore your negotiated rate is going
6:54
to update annually
6:56
um or you have managed care contracts
6:58
that are based on a grouper rate
7:00
you may have built-in escalators into
7:02
your contract meaning that every year
7:05
your group of rates increase by three
7:08
percent
7:10
or so forth for a period of times and
7:13
every year there are new codes that are
7:15
added
7:18
um to where the payers go through and
7:20
they reclassify code so groupers may
7:22
change throughout the year
7:25
um so it’s a good idea to review and
7:28
analyze your charge master
7:30
because what you will find is if you’re
7:32
not doing that analysis on an annual
7:34
basis you may eventually find yourself
7:38
under billing
7:39
not getting the reimbursement that you
7:42
expected
7:44
um are deserved in an ASC yeah it makes
7:48
sense and from a business impact and
7:50
revenue impact perspective
7:53
it certainly makes sense to me that we
7:55
don’t we don’t want to under Bill and so
7:57
you know it would be good practice for
7:59
Center to do this on an annual basis can
8:01
you walk me through you know the
8:03
recommended process you’d recommend to
8:05
an ASC that wants to do an annual review
8:07
of their charge master
8:09
absolutely so typically you know I’m I
8:14
love Excel and Excel is my best friend
8:16
so I didn’t know my analysis on Excel
8:20
um so I usually keep for all of the
8:22
clients that I do an analysis for
8:24
um I have all of the fee schedules on
8:27
one Excel sheet for that client
8:30
um that includes you know your Medicare
8:32
your workers comp your Managed Care
8:34
contracts Etc any
8:37
payer that I have a set fee schedule for
8:39
I have it loaded on one Excel document
8:42
yep and columns and then I have my
8:44
charge Master on there as well
8:46
I’m going to have Excel
8:50
um pull out my highest fee
8:52
for every procedure that that client
8:55
does
8:57
going to analyze that against my charges
9:00
and I’m going to make sure that the
9:01
charges if they are under the highest
9:04
fee then that tells me that I need to up
9:08
and do a charge Master increase
9:11
that’s the quickest and simplest way
9:14
to do it it takes minutes if you’ve
9:18
already prepped your Excel document and
9:21
done your loaded your fee schedules in
9:25
um what you have to consider before you
9:27
do a charge Master increase
9:29
is that you need to really know your
9:32
contracts because there are payers payer
9:35
contracts that may have limitations into
9:38
increases built into their contracts so
9:40
they may limit you on a percentage that
9:43
you can increase
9:45
they may limit to you on
9:47
time frames that you can increase
9:50
maybe saying you can only increase every
9:51
two years or so forth and they may also
9:54
have guidelines as to Notifications
9:56
required for your intent to increase
10:01
um so really know your payer contracts
10:05
before you go jump into this and do an
10:08
over an overall increase
10:12
um so there’s sounds like there’s Nuance
10:14
in in these in these contracts and you
10:17
and you really got to get into the
10:18
detail are there other pitfalls
10:23
yeah so
10:24
really the
10:27
other thing you want to consider is as
10:29
you’re increasing these charges is you
10:32
want to
10:34
you wanna you definitely want to
10:36
increase them higher than your highest
10:38
negotiated fee
10:40
but you also don’t want to increase them
10:42
so high that your adjustments are
10:44
through the roof
10:46
give yourself a reasonable cushion
10:49
if you know that your contracts are
10:52
mostly based off of Medicare and it’s
10:54
going to be a annual update
10:58
you may want to give your cushion enough
11:01
to where you don’t have to increase it
11:02
every year that your cushion is still
11:05
going to support those changes with
11:07
those contracts on a yearly basis
11:10
but don’t do it so high to where your
11:13
adjustments are
11:15
just through the roof
11:17
um
11:18
that’s extremely important if an ASC
11:21
decides to do contractual adjustments at
11:23
payment posting instead of at billing
11:26
because their AR will always reflect
11:28
that growth which is not an accurate
11:30
representation of what they expect to
11:32
come in
11:34
because the adjustments are not
11:35
calculated in so
11:39
there are a couple nuances you have to
11:42
consider when you are doing these charge
11:44
Master reviews
11:46
got it that that makes sense
11:49
um
11:50
in terms of the implications sounds like
11:52
your your recommendation is to do this
11:54
on an annual basis from an implication
11:56
standpoint for folks that that don’t do
11:58
it that often you mentioned under
12:00
billing
12:01
because things things can change are
12:04
there any other major implications that
12:06
folks need to keep in mind yeah yeah so
12:08
the implications really are you know
12:11
like you said the under billing
12:14
um
12:15
there are you know for example the
12:18
actually the biggest indicator that a
12:21
surgery center needs to review their
12:24
charge Master is when they start seeing
12:26
payers pay a hundred percent of their
12:28
bill charge
12:30
I know that sounds great in theory
12:33
but what that means is is that the payer
12:35
doesn’t have to take any adjustment
12:37
because you are under billing their
12:39
allowance
12:41
so for instance if your contract says
12:44
that Sigma for a knee procedure needs to
12:46
pay you five thousand dollars but your
12:49
charge is only 3 500.
12:53
Cigna technically off they have to pay
12:55
you is 3 500. because that’s what you
12:58
build them
13:00
so you really don’t want to see that 100
13:02
of Bill charge
13:05
on these negotiated payers that’s a big
13:07
indicator
13:09
what this analysis is going to show you
13:12
is not only
13:13
you’re under billing but let’s say that
13:16
you have carve outs negotiated with
13:18
let’s say Aetna and for a certain
13:21
procedure you’ve negotiated eleven
13:23
thousand dollars with Aetna and this
13:25
charge master in this contract was
13:28
created at the time ASC opened and it’s
13:30
been years it’s never been updated or so
13:33
forth
13:34
you did the initial analysis and
13:36
negotiation based off that Medicare
13:38
didn’t pay for the procedure or that
13:40
Medicare paid a certain amount for it or
13:42
so forth and now based off of all the
13:44
CMS changes and new codes coming in and
13:47
allow procedures Medicare now pays 11
13:49
500.
13:53
this is going to give you tools to be
13:55
able to go back to those payers and
13:57
renegotiate better rates so fantastic
14:01
and so this seems like low-hanging fruit
14:03
Tiara in terms of hey let’s make sure
14:05
you know every year on an annual basis
14:07
we’re going through and making sure
14:08
we’re not leaving dollars on the table
14:10
from a revenue perspective but ASE
14:13
administrators are busy business
14:15
managers are busy
14:17
for ases that need help with with the
14:20
process like this what would you
14:22
recommend who who what types of
14:24
companies and resources are available to
14:25
help
14:26
you know the companies that are
14:28
available to help are you know there are
14:30
revenue cycle management companies such
14:32
as you know serving medical billing
14:34
which is who I work for
14:36
um there are
14:37
um you know
14:38
Managed Care
14:40
um
14:41
management companies
14:44
um other than that there’s simple Excel
14:48
tutorials that can make this process
14:50
five ten minutes
14:54
um this doesn’t have to be a long
14:56
process to that will take all day
15:01
um and so forth it is a very simple
15:04
process once you know how to plug the
15:07
formulas into Excel and IT pretty much
15:10
does all the work for you
15:12
fantastic
15:13
um and you mentioned RCM companies can
15:15
can help with services like this and
15:17
kind of within the RCM
15:19
provider Sweet Spot can you tell us just
15:22
a little bit about Serb in medical and
15:24
specifically kind of how you guys
15:26
position your services within the
15:28
overall ASE RCM space sure so serpent
15:33
medical billing we are a we kind of
15:36
build ourselves as a concierge
15:40
um ASD billing and revenue cycle service
15:43
we offer a very personalized package to
15:46
our clients it goes beyond just coding
15:48
and billing for the ASC
15:51
um we act as an extension of their
15:53
business office
15:55
and assist in navigating various hurdles
15:58
such as charge Master analysis
16:00
um
16:01
that the ASE May encounter in the
16:03
revenue cycle process
16:05
um
16:06
so we we kind of look at ourselves as
16:09
partners with the ASC
16:11
to um offer those unique and
16:13
personalized services
16:16
fantastic
16:18
and last question for you here today
16:20
Tara we do this every week with our
16:21
guests what is one thing our listeners
16:23
can do this week to improve their
16:25
surgery centers
16:27
charge master and
16:29
[Music]
16:31
um it really is truly a very simple
16:33
process to do
16:36
um I know it sounds scary and it sounds
16:38
big but it truly is not
16:41
um and it will really
16:43
had your facility into the right path
16:45
for 2023
16:47
um to get that information that you need
16:50
and like you said it’s low hanging fruit
16:51
but it’s quick low hanging fruit
16:54
that’s the kind of looking fruit we like
16:56
the best Tara thanks so much for joining
16:58
us today appreciate it
17:03
[Music]
17:06
as always it has been a busy week in
17:08
healthcare so let’s jump right in our
17:11
first story comes from Med City News and
17:14
they’re sharing some heartwarming news
17:15
from Blue Cross North Carolina
17:18
due to fewer employees working on site
17:20
their cafeteria is seeing less and less
17:23
activity and remains relatively empty
17:27
so they saw this as an opportunity and
17:30
decided to use the cafeteria to prepare
17:32
meals and then distribute them to more
17:35
than a dozen non-profits in the area
17:37
which then provide the meals to those in
17:39
need to their communities
17:41
North Carolina actually has 1.6 million
17:44
households that don’t have enough food
17:46
so their work will make a huge
17:49
difference to this community
17:52
um and the payer’s on-site meal delivery
17:55
program has already shared some
17:57
impressive numbers about 3 400 meals
18:00
were distributed in January and they
18:03
hope to distribute another 4 200 in
18:06
February
18:07
um now what started off as a temporary
18:09
winter program that’s kind of what they
18:11
called it
18:12
um you know it was only supposed to run
18:14
for three months and it is still set to
18:16
end on March 31st but they’re thinking
18:18
they might continue on long term they’re
18:21
currently evaluating if it’s something
18:22
that they can continue with and I think
18:25
we can all hope that they do according
18:28
to an article from Healthcare dive the
18:30
HHS office for civil rights or OCR
18:33
receives 39 more HIPAA complaints in
18:37
2021 than they did from 2017. and large
18:41
breaches affecting 500 people or more
18:43
increased 58 in that same time period
18:47
this information was shared in the
18:49
agency’s annual report to Congress along
18:52
with the unfortunate reality that while
18:54
complaints have increased within that
18:56
four-year time period the Staffing and
18:59
resources have not which is obviously
19:01
causing a severe strain on existing
19:03
employees
19:05
um the article did share a few examples
19:07
of investiga Investigations that the OCR
19:09
did have the resources to follow up on
19:12
and one that caught my eye was from
19:15
January 2021 when excellus agreed to pay
19:19
5.1 million dollars after an
19:22
investigation revealed poor cyber
19:24
security practices that led to a data
19:27
breach of the PA of Phi of more than 9.3
19:30
million patients
19:33
um so at a time where cyber or security
19:36
attacks on the health care industry are
19:38
becoming more and more common the agency
19:40
that is supposed to be there to help
19:42
protect patients and keep Health Care
19:43
Facilities in line
19:46
um is not properly staffed or funded to
19:49
do so at the volume that is needed so as
19:52
always the moral of the story is to
19:54
invest in your cyber security measures
19:55
educate your staff and just always err
19:59
on the side of caution
20:01
our next story is All About the
20:04
potential of Technology when it comes to
20:06
patient patient engagement and the
20:08
patient experience
20:11
um the Ohio gastroenterology group was
20:14
averaging about 50 000 phone calls per
20:17
month from patients and it became nearly
20:19
impossible for them to handle patients
20:22
were calling for every little thing
20:24
looking for information on time you know
20:27
the address parking clinical concerns
20:30
and and anything else that came up they
20:32
had nowhere else no way else to reach
20:34
out to them except for picking up the
20:36
phone so they really needed a solution
20:38
to overcome this huge time suck and it
20:41
was also causing patient dissatisfaction
20:43
because they couldn’t get a hold of
20:45
anyone and had to leave voicemails and
20:47
it just wasn’t working
20:49
so they decided that they needed a
20:51
change and they decided to roll out a
20:54
few initiatives
20:55
um the first is they plan to gradually
20:58
Implement text messaging email and
21:00
mobile apps to take over that patient
21:03
communication the second is to provide
21:06
richer more helpful information on their
21:08
website so patients I feel like patients
21:11
would prefer most patients to go to a
21:13
website find their own information real
21:15
quick then having to wait on hold and
21:17
leave voicemails and stuff so
21:20
um highly recommend that if you haven’t
21:22
taken a look at your website make sure
21:23
that you’re providing as much helpful
21:25
information as you can
21:27
um but back to the Ohio gastro group
21:29
along the same lines as those the two uh
21:33
initial initiatives that they’re working
21:34
on the third is to implement a smart
21:37
virtual assistant that will be powered
21:39
by conversational AI on their website
21:41
through text and also voice and then
21:44
they’re also working on implementing
21:45
referral scheduling functionality that
21:48
enables patients to book
21:50
um appointments digitally and online
21:52
without having to pick up the phone
21:54
so I highly highly recommend giving this
21:57
article a read what I shared is just
21:59
really the tip of the iceberg of what
22:01
this group is doing and it actually
22:03
really lays out a full action plan of
22:05
how Healthcare groups regardless of
22:07
their size can roll out technology in an
22:10
effective way the reality is if you’re
22:12
not using patient engagement technology
22:14
you’re missing out on a ton of
22:16
Automation and Time Savings on your end
22:19
um and you’re also not providing the
22:20
preferred patient experience so I think
22:24
um you know while it can seem
22:25
overwhelming this article does do a
22:28
great job of showing a very real
22:30
situation
22:32
um where a facility was able to roll out
22:34
patient engagement technology
22:35
successfully
22:38
and to end our new segment on a positive
22:40
note doctors made history at the
22:43
University of California San Francisco
22:45
when for the first time ever a heart
22:47
transplant was performed by an all-women
22:50
medical team a 2019 report found that
22:54
only six percent of adult cardiac
22:56
surgeons in the U.S are women so that’s
22:58
what really made this stand out
23:00
the odds that all seven members of the
23:03
team were women is extremely rare So Dr
23:07
Amy feidler attending cardiac surgeon
23:10
and assistant professor said that it is
23:12
profound to think that by doing our jobs
23:15
we can Inspire women to live what they
23:18
want to do live out their dreams and
23:20
recognize that anything is possible
23:23
and that news story officially wraps up
23:25
this week’s podcast thank you as always
23:27
for spending a few minutes of your week
23:29
with us make sure to subscribe or leave
23:32
a review on whichever platform you’re
23:34
listening from I hope you have a great
23:36
day and we’ll see you again next week
23:40
[Music]
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