Description:

A charge master audit is a systematic review process conducted in healthcare organizations to ensure accurate billing and coding services provided to patients. It involves reviewing the medical record documentation, billing information, place of service codes, billing provider, etc. to verify that all services rendered are appropriately documented and billed for. Healthcare billing is subject to numerous regulations and requirements, including those set forth by federal payers like Medicare and Medicaid. Charge capture audits help ensure compliance with these regulations, reducing the risk of legal and financial penalties associated with billing errors or fraudulent practices. Chargemaster audits ensure financial integrity by billing correctly for the services provided.

By identifying missed charges or coding errors, charge capture audits help healthcare organizations optimize their revenue. Proper documentation and coding of services provided can maximize reimbursement from payers and improve the organization’s financial performance. It prevents underbilling, which can lead to revenue loss, and overbilling, which can result in compliance issues, fines, or reputational damage. Charge capture audits are essential for maintaining financial health, operational health, and compliance within healthcare organizations, making them an integral part of revenue cycle management and healthcare administration. Chargemaster audits play a critical role in a healthcare organization’s revenue cycle management by ascertaining the accuracy of billing processes, ensuring compliance with regulatory requirements, streamlining workflows, and optimizing reimbursement for healthcare services provided to patients.

Session Highlights:

• Understand the purpose of a charge master audit and its importance
• Recall common errors related to the charge capture workflow
• Recognize how errors negatively impact the organizations
• Understand who should be involved in all aspects of the charge capture process
• Identify various corrective action steps that can be taken in response to a charge master audit

Session Agenda:

• Define the role of a charge master audit and why it is important.
• Discuss how the charge master impacts the revenue cycle from an operational perspective.
• Identify common errors related to the charge capture workflow.
• Discuss various complicating factors to the charge capture workflow.
• Describe ways that errors in the charge capture process impact the organizations.
• Discuss who should be involved in establishing a charge audit process.
• Identify expected outcomes from a charge capture audit.
• Analyze charges to develop a pricing methodology and strategy for determining the reasonable value of services.
• Discuss examples of next steps following a charge master audit.

Who Should Attend

• Medical Coding Specialists
• Medical Billing Specialists
• Medical Auditing Specialists
• Private Practice Physicians
• Managed Care Professionals
• Operations Leadership
• Practice Administrators
• Office Managers
• Compliance Officers/Committees
• Chief Medical Officer

Speaker Profile

Toni Elhoms is an internationally known speaker and recognized subject matter expert on medical practice management, coding, reimbursement, revenue cycle management, compliance, and fee analysis. She is the Founder and CEO of Alpha Coding Experts, LLC (ACE). She holds multiple credentials with the American Health Information Management Association (AHIMA), the American Academy of Professional Coders (AAPC), and the National Alliance of Medical Auditing Specialists (NAMAS). Ms. Elhoms’ expertise extends to both inpatient and outpatient coding, compliance, billing, and reimbursement. She has extensive medical coding, billing, and auditing experience in the following specialties: orthopedic surgery, spine surgery, neurosurgery, cardiology, interventional cardiology, general surgery, oncology, hematology, internal medicine, family practice, geriatrics, pediatrics, pain management, neurology, urology, hospital medicine, critical care, and other practice areas.

Ms. Elhoms serves as ACE’s Senior Consultant and conducts training and educational seminars across the country on a variety of topics including, but not limited to, Medical Coding, Medical Billing, Practice Management, Managed Care, Revenue Cycle Management, Revenue Maximization, Regulatory Compliance, The Social Determinants of Health (SDoH), ICD-10-CM and PCS, Surgical Specialty Coding, etc.

With well over a decade of industry experience, Ms. Elhoms has led and supported hospital systems, universities, physician practices, payers, law firms, government agencies, and other entities on coding, billing, and compliance initiatives. Ms. Elhoms is a frequent contributor to various media outlets, highly sought-after conference speaker, and regular guest on industry podcasts. Ms. Elhoms frequently serves as an expert and consulting witness in litigation matters.

Ms. Elhoms was appointed as an editorial advisory board (EAB) member for The Coding Institute (TCI) in 2020. She created the Alpha Coding Podcast series (rated a top industry podcast) to share her industry Pro-Tips. She is a regular volunteer and mentors a network of Revenue Cycle Management (RCM) and Health Information Management (HIM) professionals across the United States. She proudly served as the 2020 and 2021 elected President of the Orlando, FL AAPC Chapter. She is also an active member of the Florida Health Information Management Association (FHIMA) and the National Alliance of Medical Auditing Specialists (NAMAS).

Ms. Elhoms is a wife and mother of 3 beautiful children. She enjoys reading, biking, playing poker, and beach trips with her family.