A line item review of your facility's CDM (Charge Description Master), including CPT/HCPCS and UB04 Revenue Codes. Done on a departmental basis and compared against other documents (i.e., Revenue and Usage, Charge Linkage Report), this will assess reliability and improve the accuracy and thoroughness of reporting activity and associated costs. Benefits of this process include:
- Linking of HCPCS/CPT and revenue codes
- Inconsistent naming/numbering schemes
- Inactive/obsolete codes, missing codes and descriptions, lost procedure and companion codes
- Inefficiencies in current charging processes (see CPM)
- Non-compliance with federally funded health care programs
- Comparison to Medicare Fee Schedules
- Duplicate charges
- Reconcile unrealized and potential revenue
Additional Features:
- On-site interviews with appropriate department representatives
- UB04 Audit Impact Tests both pre and post review, including medical necessity,
- Facility wide educational session on reimbursement
- Assessing coding and billing responsibilities (hard coded vs dynamic)
- APC specific billing and coding education
The primary benefit is to assure the PMR reflects, tracks and reports activities/resources consumed.
