Ministry Door County Medical Center (MDCMC) in Sturgeon Bay, Wisconsin, is an acute care hospital and outpatient medical center with 25 licensed beds. MDCMC has been the leader in health and wellness for the Door and Kewaunee communities since 1943. The medical center offers a full range of services and specialties including home health, a skilled nursing facility, rehabilitation services, and clinic.

Situation

It had been roughly five years since MDCMC engaged an outside expert to review its chargemaster. During that period, the organization transitioned its chargemaster coordinator position twice, and numerous Medicare and CPT rules and codes had changed. While the medical center prides itself on staying current with changes, it also recognized the value of an expert review and reached out to Wipfli.

Strategy

Wipfli performed a complete assessment of the organization’s chargemaster, both for the hospital and the clinic. An on-site visit was then conducted wherein clinical leaders and the chargemaster coordinator were interviewed. Wipfli also reviewed a sampling of patient encounters from start to finish to identify any potential charge capture issues.

Wipfli briefly shared its findings in an on-site exit conference before compiling a detailed report. The report served as a working document from which to implement necessary changes. The medical center’s revenue cycle team then prioritized the opportunities and began working through the list as appropriate.

Benefits

The overall findings from the review were not altogether significant, which pleased the medical center. They provided validation that MDCMC had been managing its chargemaster appropriately.

However, Wipfli did identify several key opportunities, which MDCMC implemented. Among them:

• Building recovery room charges into the chargemaster and billing for the service when appropriate.
• Rolling nursing acuity charges into tiered room-and-board charges to continue to capture the variability in inpatient services in a more appropriate way for insurance companies, which are typically averse to processing nursing acuity charges separately.
• Creating a new way of billing for transfusions.