Comprehensive CDM Review

Our comprehensive CDM review is a line item review of PMR or CDM, including CPT-4/HCPCS and UB04 Revenue codes. This review is done on a departmental basis and is compared against other documents such as Revenue and Usage and Charge Linkage Reports. The review process includes on-site meetings with departmental representatives, pre- and post-UB04 audit impact tests, assessment of coding and billing responsibilities, and discussion of current billing and coding issues.

What This Service Includes

Specific areas that are reviewed include:

  • Validation of CPT/HCPCS codes currently assigned in the CDM
  • Identification of charge codes assigned an invalid or incorrect CPT/HCPCS code
  • Identification of charge codes not currently assigned a CPT/HCPCS code, for which an applicable code is available
  • Identification of charge codes that have unique billing requirements that are payor specific to Medicare, Medicaid of Alabama, and Blue Cross of Alabama
  • Identification of charge codes frequently associated with National Correct Coding Initiative (“CCI”) edits and policy
  • Identification of charge code/billing scenarios that represent a potential for:
    • Loss of reimbursement
    • Overpayment
    • Compliance issue
    • Claim suspension
  • Identification of services that may be provided that are not currently available in the CDM
  • Identification of CPT codes that are valid, but not recognized by Medicare
  • Review of conversion factors, specifically in Pharmacy
  • Review appropriateness of revenue codes currently assigned in the CDM
  • Review appropriateness of CDM descriptions for clarity and consistency within the department
  • Review of linked/associated charge codes

How You Can Benefit From This Service

The overall objective of a comprehensive CDM reviews is to create a concise document that controls and reflects the current operations of the Medical Center, delivery of care, modalities, and technologies. This review assures that the PMR reflects, tracks, and reports activities/resources that are consumed. This review can highlight areas where charge codes are used incorrectly, errors in coding cause overpayment, and other compliance issues.

We help our clients benefit from this review by:

  • Conducting in-depth reviews of internal processes
  • Bringing to light charge codes that need further review and revision
  • Discussing the compliance implications of using "hot spot" charge codes incorrectly
  • Identifying areas of potential non-compliance
  • Educating departments about current billing and coding topics and issues