Charge-process strategies for outpatient prospective payment.

Area of Science:

• Healthcare Administration
• Health Economics
• Medical Billing

Background:

• Operating successfully under the outpatient prospective payment system (OPPS) requires robust financial management strategies.
• The chargemaster and associated charging processes are central to revenue cycle management in healthcare settings.

Purpose of the Study:

• To outline essential strategies for developing and maintaining an effective charging process within the outpatient prospective payment system.
• To emphasize the importance of chargemaster assessment and ongoing monitoring for financial control.

Main Methods:

• Assessment of chargemaster coding and charge structure.
• Analysis of hospital department charge utilization.
• Development of a system for ongoing monitoring and maintenance of the chargemaster and charging process.

Main Results:

• Identification and correction of problems within the chargemaster and charging process are necessary first steps.
• A comprehensive monitoring system is required to sustain improvements.
• Effective feedback mechanisms to departments regarding charge process errors are critical for sustained accuracy.

Conclusions:

• An effective charging process, beginning with chargemaster accuracy and departmental charge use, is vital for outpatient prospective payment system success.
• Continuous monitoring and departmental feedback are essential components of a sustainable charge process management system.