The Forgotten Chargemaster

It is the beginning of a new year and time for providers to review and update their CDMs.  Hundreds of CPT and HCPCS changes were implemented on January 1, 2017 along with payor pricing revisions.  It is crucial for every organization’s financial and compliance success to ensure these changes are reflected accurately within the CDM in a timely manner.

Ideally, every provider should be reviewing and updating their CDM on a quarterly basis.  The CDM should never be reviewed and updated less than annually.  Additionally, external, independent reviews should be conducted regularly to validate revisions are being implemented comprehensively and correctly.  Due to the rapidly changing code sets as well as billing and reimbursement rules, properly reviewing and updating your CDM less than annually can lead to significant loss in revenue in addition to dramatic increases in denials and compliance risk.  However, when asked, many providers have indicated they have not conducted an external review of their CDM for 8-10 years, on average.

The American Association of Procedural Coders (AAPC) has stated, “Approximately 75 percent of outpatient services are driven by the CDM.”¹  and they recommend the following:²

1. Review at least annually.

2. Maintain updates throughout the year as new procedures or supplies are incorporated in the hospital service line.

3. Review and maintain payor information (bulletins, transmittals) and make CDM adjustments based on that information.

We have a team of CDM experts that includes certified coders as well as individuals Certified in Healthcare Compliance who personally review each line item within your CDM.  We utilize a team approach to ensure you are provided with accurate, detailed recommendations to ensure appropriate charge capture and reimbursement while reducing denials and compliance risk.

Attached is some additional information about your CDM and its impact on your financial success.  If you would like details regarding our CDM or other services, please contact teaton@hbeadvisors.com.

DISCLAIMER:  This newsletter contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations given are general and specific questions should be directed to professional counsel.

¹ American Academy of Professional Coders, Certified Outpatient Coder:  COC™ 2015 Study Guide, Page 41.

2 Ibid.