Charge Master Management Solutions

The Vendor is required to provide to manage and operate a charge master management solution that includes an auditing solution, a regulatory reference solution, and a medication analytic solution
•    The auditing software analyzes an extract of the live charge master (CDM) and details potential discrepancies while suggesting possible solutions. 
•    The auditing solution must be able to ensure that all services rendered are accurately captured and billed to reduce revenue leakage. 
•    The regulatory reference solution must support users with immediate access to comprehensive clinical, coding, financial, and regulatory reference data. 
•    The medication analytic solution assesses purchase, billing, and remittance data sets to provide visibility into margins, at the medication level, giving pharmacy leaders the insights needed to make informed business decisions on a multitude of pharmacy-related areas.
- Requirement 
•    Providing charge master management solution that includes auditing, regulatory reference and medical analytic solutions.
•    The charge master management solution must have an automated charge master solution that can manage the charge master and conduct in-depth charge master analysis to optimize revenue. 
•    The charge master management solution must have at least three (3) current clients, which are hospitals or medical centers, including one client who must be based in state, and for whom the vendor has provided a charge master management solution, similar in size and scope to that sought by agency for two (2) years or more. 
•    The auditing, the regulatory reference and the medication analytic solutions in the charge master should all exist on the same platform with the same user interface and experience across all three (3) solutions. 
•    The charge master management solution and the vendor offering the solution must have support available during Est business hours (7 am-7 pm) with an answering service for emergency requests to be answered within 24hours. 
•    The charge master management solution must record the date, user, and effect of the change to the line item, along with the old values, for auditing purposes. 
•    The charge master management solution must provide agency with the ability to perform comparative pricing with other hospitals in the state metro area.
•    The charge master management solution must enable agency to compare its own pricing to Medicare and fee schedules to determine if they are priced below the APC guidelines. 
•    The charge master management solution must allow users to identify differences with unique flags. 
•    The charge master management pricing solution must allow agency to run pricing models without vendor involvement, to upload the final pricing model into the charge master application, and script changes into the hospital existing billing system.
•    The charge master management solution regulatory reference must provide access to AMA annual code changes and allow for analysis of the charge master to identify issues within 5 business days of AMA publication in September of each year.
•    The charge master management solution must include a regulatory reference that consolidates all Medicare, CMS, guidance into a single, accessible source. 
•    The charge master management solution must provide instant access to the most current regulatory reference from within the system.
•    The charge master management solution regulatory reference must provide access to laymen and clinical versions of descriptions for ease of use for non-clinical users. 
•    The charge master management solution regulatory reference must identify codes that are no longer paid and offer alternative codes.
•    The charge master management solution must allow agency to identify potential coding and compliance issues, notifying the user of invalid. 
•    The charge master management solution must notify users automatically of regulatory changes that can impact charges including description and value changes. 
•    The charge master management solution must have an integrated medication analytics solution that evaluates medication reimbursement, purchasing, and margin analytics. 
•    The charge master management medication analytics solution must be able to support the analysis of different medication cost structures, such as 340b pricing, average wholesale price, wholesale acquisition cost, and group purchasing organization. 
•    The charge master management medication analytics solution must provide analysis of medication purchasing patterns and details, including summaries and line-item details.
•    The charge master management medication analytics solution must provide analysis of medication reimbursement patterns and details for all physician-administered medications, including summaries and line item details for all medications and medication administration services performed in an outpatient setting. 
•    The charge master management medication analytics solution must provide detailed margins for physician-administered medications, enabling the review of margins by medication and payor.
•    The charge master management medication analytics solution must provide advanced filtering, including purchasing account type, payor group, plan, claim adjustment reason codes, and code and status indicator. 
•    The charge master management medication analytics solution must be able to assess purchase, billing, and remittance data sets to provide visibility into margins, at the medication level, giving pharmacy leaders the insights needed to make informed business decisions on a multitude of pharmacy-related areas. 
•    The charge master management solution must identify additional revenue opportunities, such as missing devices, missing reimbursable drugs, potential add-ons, and other potential costs. 
•    The charge master management solution must be able to run user-customized reports that provide a variety of filtering and a library of additional data fields (e.g., both facility-wide and user-specific, created on demand by the user) on an ad hoc basis or on schedule.
•    The charge master management solution must allow users to save and share views and exports with the application for future use.
•    The charge master made outside the charge master management solution will be noted upon import into the system electronically. 
•    The charge master management solution provides real-time analysis and validation for issues when changes are made to a line item or potential coding issues. 
•    The charge master management solution must have a user-friendly interface that can be customized by the user to make CDM requests for additions, modifications, and inactivation of charge items.
•    The charge master management solution must have a medical necessity solution that provides real-time access to medical necessity and prior authorization policies for Medicare, Medicare supplements, and commercial payers.