Developed to help improve billing accuracy, strengthen regulatory compliance, and reduce payment denials for the Client by ensuring that services provided are accurately reflected in the CDM, reimbursement is optimal, and financial information is readily and accurately trackable.
The scope of the engagement includes a combination of an off-site review and on-site review with technical assistance. Our consultant specialist reviews the CDM using automated tools and technical expertise to:
Verify accuracy of coding assignment (CPT/HCPCS/Modifier/UB)
Update invalid/deleted codes
Review descriptions to ensure services are accurately reflected and meet Client’s internal standards
Identify charges missing from the CDM
Perform price comparison vs. allowable reimbursement levels
Identify compliance issues relating to the CDM
Formulate queries for on-site visit
We work directly with department staff to define within the CDM the extent of services performed in their areas, review with them any compliance issues that may be evident, and identify for them the changes needed in their current coding and billing practices. We provide education for staff regarding coding, compliance, and charging methodologies relating to their specific areas.
The final product includes on-site presentation of the hard copy chargemaster with all recommendations identified and a detailed written report with documentation sources for determining our recommendations. Electronic copy of the chargemaster data in Excel format is provided.
Value Added Benefits for this Service:
Comprehensive CDM Update
More knowledgeable staff
Coding and Billing Helpline provided at no additional cost during the term of the contract. Client’s staff may take advantage of this helpful service to answer questions arising from implementation of chargemaster recommendations.