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Biomedical subjects

D C Abbey

Publications and source records attributed to D C Abbey.

7 recordsLinked to original sources

Designing and maintaining an effective chargemaster.

The chargemaster is the central repository of charges and associated coding information used to develop claims. But this simple description belies the chargemaster's true complexity. The chargemaster's role in the coding process differs from department to department, and not all codes provided on a claim form are necessarily included in the chargemaster, as codes for complex services may need to be developed and reviewed by coding staff. In addition, with the rise of managed care, the chargemaster increasingly is being used to track utilization of supplies and services. To ensure that the chargemaster performs all of its functions effectively, hospitals should appoint a chargemaster coordinator, supported by a chargemaster review team, to oversee the design and maintenance of the chargemaster. Important design issues that should be considered include the principle of "form follows function," static versus dynamic coding, how modifiers should be treated, how charges should be developed, how to incorporate physician fee schedules into the chargemaster, the interface between the chargemaster and cost reports, and how to include statistical information for tracking utilization.

Accounting↗

Understanding the financial implications of APGs (ambulatory patients groups).

The ambulatory patient group (APG) system, a new prospective payment system for reimbursing outpatient services, is being adopted by increasing numbers of third-party payers and may soon be used in the Federal Medicare program. APGs involve the grouping of healthcare services provided during a specified service period. Payment rates are complicated by the assigning of multiple APGs to a single patients encounter and by discounting schedules. APG cost management tools must be developed to assess the financial impact of this complex system.

Ambulatory Care↗