EPreward  Serving the Heart of Cardiology

EP Newsletter

July/August, 2008

Dear EP Staff & Managers, 

 

Many EP Labs are struggling financially and are unable to build and expand their programs due to inadequate reimbursement. The goal of this article is to introduce EP staff to the reimbursement process, assist new managers in the development of economically viable programs, and help experienced managers improve their financial return. As Techs and Nurses are the only hospital staff actually in the procedure, your role in the reimbursement process is critical in order for the hospital to be paid appropriately.

 

We have added numerous links through the article including a glossary of reimbursement terms and a schematic of the reimbursement process. We have also included examples of different forms and documents in a manner that may be copied and utilized by you. This article is graciously submitted by Salwa Behiery the Director of Electrophysiology Services at California Pacific Medical Center and Marin General Hospital.  If you have insights or information to add, please submit them through the link at the end of the article and we will add them to the version archived on the website.

 

Respectfully,

Steve Miller, RN – President EPreward

 

How to Maximize Your EP Service

Revenue

 

With today’s economic realities, and with HMO and Medicare’s ever shrinking reimbursement rates, we are all faced with difficult decisions to make so we can maintain fiscally viable EP services.  The following article will highlight some of the reimbursement challenges EP directors and managers face, and offer a few tips on how to deal with them.  We start with the Charge Description Master.

This Issue

 

· Maximize Your EP Service Revenue – For Managers as well as Staff.

· Inventory time?  Sell your unused items.

· Catheter tip solicitations? Be smart.

Problem 1: Low or No

Reimbursement From Payors

 

Perhaps this is the single most important challenge facing us, and greatly affects the balance sheet of any EP program. This is not an easy topic to comprehensively cover, but here are some basic and essential steps necessary to accomplish positive results:

 

First of all, understand your Charge Description Master, also known as the “Charge Master”. This is a master electronic repository of all possible equipment and procedure charges which are used in the EP lab. It is prepared even before an EP program is opened for business. The director/manager of the program will put this CDM together with help from Decision Support and Finance (other involved parties include EP Staff, Accounting, Billing, Revenue Integrity, Purchasing, etc.). From this CDM, a Fee Ticket for each procedure is generated that is sent to the payor.

 

The electrophysiology CDM is the basic structure for deciding what supplies we will buy, what it will cost to use them, how much it will cost to do a certain procedure, and finally the total amount we will charge the patient for our time and efforts. Invest some time and perhaps some funds for expert help (Coding & Billing resources) to build an accurate and comprehensive CDM. If

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