Charge Description Master Review

Process

In starting the comprehensive CDM review, a St. Clair Senior Consultant checks the CPT/HCPCS codes and service descriptions of all Hospital ancillary services for compliance with the CMS regulations and the applicable Local Medical Review Policies. Also, St. Clair checks the Hospital and/or Medicare billing edit reports for any frequently repeating coding/billing errors in order to identify any caused by CDM problems.  For a sample of Medicare outpatient visits, the consultant performs and audit of the UB-04s against the coded ambulatory services per the medical record in order to identify any CDM problems.

Based upon the above-indicated CDM review, St. Clair identifies its problem findings in a rough draft of a service “line by line” Excel report for each ancillary department.  This report is forwarded to the hospital client for review by the involved ancillary department heads whose feedback can obtained through exit conference calls or on-site consultant meetings.

Based upon the department head feedback, St. Clair prepares and forwards, to hospital financial management for review in advance of an exit conference, a draft narrative summary of CDM findings and recommendations by department and attaches an Excel report of recommended service line item changes with supporting documentation for each department.  After obtaining sign-off as to having answered all management questions regarding the draft report, St. Clair issues the final report.

Benefits

The St. Clair CDM review establishes accurate CPT/HCPCS codes in the Hospital billing which assures proper payer payments.

Pricing Approach

The St. Clair professional fee for a comprehensive CDM review is competitively priced on consultant days required to complete the engagement, plus out of pocket expenses.