Providers have been faced with many costly challenges over the last several years. There has been a substantial decline in revenues and profits due in part to one of the worst recessions in history combined with tremendous financial outlay to implement Electronic Health Records (EHR) and ICD-10, as well as the cost to respond to ever increasing payor audits and requests.
Due to limited staff and financial resources, many providers have not had the opportunity to focus on internal prospective routine reviews.
A key component to every hospital’s success, or demise, is an accurate, effective, and up-to-date Charge Description Master (CDM). With the implementation of EHRs and ICD-10 behind us, we have seen a significant increase in requests to perform CDM reviews. When asked, providers are admitting they have not conducted a review of their CDM for 8 to 10 years, on average.
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. Due to the rapidly changing code sets as well as billing and reimbursement rules, if your CDM is not properly reviewed and updated at least annually it can lead to significant loss in revenue in addition to dramatic increases in denials and compliance risk.
Per the American Association of Procedural Coders (AAPC) “Approximately 75 percent of outpatient services are driven by the CDM.”1
The AAPC indicates “many facilities review the CDM quarterly or semiannually.” They also recommend the following:2
- Review at least annually.
- Maintain updates throughout the year as new procedures or supplies are incorporated in the hospital service line.
- 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.
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1 American Academy of Professional Coders, Certified Outpatient Coder: COC™ 2015 Study Guide, Page 41.