• Benefit from the use of our proprietary in-house software, and our traditional hands-on review with Education.  Using the hybrid approach of cutting edge software and senior level consulting helps ensure that PRC’s recommendations are truly understood by the facility. PRC reviews findings with the hospital staff on-site, and makes specific recommendations and comments based on discussions with your departments.

  • Meetings with Department Managers:
    • ​​Reintroduce each Department to their respective Charge Masters
    • Discuss Charging Processes, Order Entry, and Charging Methodologies
    • Evaluate and improve Line Item Descriptions and Selection process
    • Address Denial/Edit activities associated with Charge Master charges

  • ​​Address Line Item and Order Entry Utilization issues. Staff must select the appropriate Line Items in addition to having a well maintained Charge Master.

  • ​Identify opportunities to bill for services currently provided which are not being captured, and also look for compliance risks represented by items that you should not be billing separately, focusing on Optimizing Reimbursement while achieving Compliance.

  • ​Strategic Pricing Analysis based on geographical location and/or reimbursement.

  • Audit a sample of Charge Master driven medical record encounters and associated billing documents:
    • Identify billing/mapping issues
    • Review reimbursement levels relative to coding, billing, and charges
    • Evaluate disconnects in understanding HIM driven coding vs. Charge Master driven coding (i.e., double coding)
    • Check for proper generation of codes and charges on claim

  • Provide off-site support throughout the duration of the contract:
    • Provide support and feedback on rejected, suspended, or underpaid claims due to Charge Master issues
    • Assist with setting up new Line Item charges, or entirely new service areas in the Charge Masters

A Description Of PRC's

Charge Master Review

  • Ensure the Accuracy of the CPT/HCPCS Codes
  • Ensure the Accuracy of Revenue Center Code Assignments
  • Ensure that Line Item Descriptions match the CPT Codes exactly
  • Ensure that the use of Modifiers is correct
  • Verify the proper Handling of Edit Activity (OCE and NCCI Edits)​
  • Review Pharmacy Multipliers (ie., Conversion Factors)
  • Verify GL/Department Revenue Assignment and Mapping
  • Validate the utilization of Charge Explosions
  • Ensure  Coding & Billing is accurate and at optimum levels
  • Ensure Compliance standards are being met
  • Identify services provided with no mechanism for charging
  • Conduct a Fee/Charge Analysis for the Specific Geographical Location
  • Identify Order Entry Issues
  • Identify Volume/Usage Issues

PRC’s Charge Master Review services focus on ACCURACY, COMPLIANCE, EDUCATION, and your receipt of OPTIMUM REIMBURSEMENT.

The project includes a preliminary off-site review with PRC's proprietary software, along with time on-site at your facility to further identify opportunities. While on-site, PRC will make recommendations for change and provide Education to departments regarding the Charge Master and charging methodologies and processes to ensure you are meeting and maintaining compliance. In addition to an accurate Charge Master database, PRC helps ensure that your staff understands the Charge Master, and practices appropriate utilization of line item charges.

In addition to the Charge Master database review items, we will review a sample of medical records, along with the associated UB-04s and Detail Bills, in order to verify that all charges are supported by the documentation and are appropriately mapping to the claim. Our comprehensive Charge Master Reviews also include OFF-SITE SUPPORT for assisting on ongoing Maintenance. 

Major Review Items

Some Key Elements