The feasibility study is a review of the current chargemaster and revenue and usage data for the facility the Client is considering purchasing. The review is concentrated on coding accuracy, and potential areas of reimbursement enhancement as well as potential issues with non-compliance. The areas addressed in the feasibility are used to determine potential revenue impacts.
HMI will review, line-by-line, all the active departments listed in the hospital chargemaster. Listed are items reviewed:
Assigned CPT/HCPCS for accuracy
Assigned UB revenue code for accuracy
Assigned modifier for accuracy
Assigned charge for pricing below published Medicare reimbursement rates
Missing charges for addition
Deleted/invalid charges for modification
HMI will review the revenue and usage data to validate line items with activity. The information in this report will be used to prepare a quantifiable impact report:
(a) address reimbursement enhancement for missing charges/codes, and
(b) address revenue associated with areas of non-compliance.
HMI will submit a report of findings and recommendations. Information provided in the report will be supported by current published CMS coding and billing guidelines. The hospital should implement changes in the hospital system for the most optimal reimbursement opportunities.