COMPREHENSIVE CHARGE MASTER (CDM) REVIEW
Process
During the off-site CDM review component, St. Clair checks the CPT/HCPCS and Revenue Codes and Service Descriptions of all Hospital ancillary services for compliance with the CMS regulations and the applicable Local Medical Review Policies (LMRPs). We identify any "hard coded" services, which are recommended for soft coding, or vice versa. Also, we check the Hospital and/or Medicare billing edit reports
for any frequently repeating coding/billing errors in order to identify any caused by CDM problems.In on-site individual meetings with ancillary departments, St. Clair will confirm our preliminary findings and recommendations and provide an educational in-service. We also perform an audit of the UB-92s against the medical records for a sample of Medicare outpatient visits in order to identify any CDM problems. Within two weeks after the on-site exit conference, St. Clair will complete the final report, including recommended CDM code changes, with supporting documentation, in the same Excel spreadsheet format as provided by the Hospital.
As an option, St. Clair will use the Ingenix Chargemaster Analyzer Software to assist our Senior Consultants in the review of the CPT/HCPCS and Revenue Codes and Service Descriptions. By means of the Software, St. Clair is able to provide the Hospital with the following additional reports: Best Practices Report for each ancillary department as to "missing" CPT/HCPCS codes; comparison of the Hospital charges with the current "regionally adjusted" Medicare APC payment rates & fees; and inquiry reports, comparing the Hospital "outpatient charge" line items with the 2003 average price & cost MEDPAR data for all hospitals in its Metropolitan Statistical Area. Also, during the first 90-days after the onsite review, St. Clair performs a follow-up, off-site CDM review against the Software edits to assess the Hospital’s implementation of our recommended CDM changes.
Pricing Approach
The St. Clair price for the Comprehensive CDM review is fixed, plus out of pocket expenses. During the first 90-days after the on-site review, at no additional charge, St. Clair will provide consultant support, via telephone and email, on any questions about the final report and the CDM impacts of regulatory/coding changes.