CDM Cleanup

The general scope of this project will encompass a complete comprehensive review of the Charge Description Master (CDM), including: Usage, Description, Revenue Code assignment, CPT/HCPC code assignment, Modifier assignment and Pricing.

The CDM Review Methodology:

Each departmental session starts with full introduction of the layout of each of the three MedCompliance Services Editors that are in an Excel format. The next step is a review with each department director and staff of every CDM line in their department for accuracy, compliance and revenue opportunities. At the end of each session the department director is emailed a copy of the editor's results and findings as analyzed and discussed for their respective department.

The CDM review will accomplish the following objectives:

1. Review CDM for Description Issues:

• Validate all existing Descriptions in CDM is correctly identifying procedure, service, device and drug.
• Identify all items with missing Descriptions.
• Determine if the same Description is used more than once in CDM.
• Identify all Descriptions that start with a number or a space.
• Identify Descriptions that contain words such as "miscellaneous" or "other" for possible inactivation

2. Review CDM for correct UB Revenue coding:

• Validate all existing Revenue Codes in CDM are correctly assigned.
• Identify all items with missing Revenue Codes.
• Determine the validity and accuracy of Revenue Codes to listed item descriptions.
• Determine the validity, accuracy, and alignment of the Revenue Codes to listed CPT/HCPCS codes.
• Review all items with professional component, patient convenience, and "statistics" Revenue Codes for accuracy and validity.

3. Review CDM for correct CPT/HCPC coding:

• Validate all existing CPT/HCPC codes in CDM are correctly assigned.
• Identify all items with missing CPT/HCPCS codes.
• Review all same CPT/HCPC coded item for uniformity in description.
• Review the validity and accuracy of the CPT/HCPCS codes to listed item description.
• Evaluate all relevant CPT/HCPC and Revenue Code combinations for each clinical department such as "panels/explosions" used for compliance with regulations.
• Review and add all missing CPT/HCPC codes that have assigned Revenue Code 275 - Pacemaker, 276 - Intraocular Lens, 278 - Implant and 636 - Drugs requiring detailed coding.
• Evaluate all CPT/HCPC coded drugs and radiopharmaceutical agents for dosage and multiplier compliance
• Provide recommendations for missing reimbursable CPT/HCPC codes.

4. Review CDM for Modifier issues:

• Validate all existing Modifiers in CDM are correctly assigned.
• Review how Modifiers are assigned/selected and the rules of assignment.
• Discuss benefits to assigning Modifiers in CDM instead of by HIM.
• Identify all items with required Modifiers that are missing.
• Determine if assigned Modifier is accurate.

5. Perform Usage evaluation:

• Identify all items in CDM with no Usage for past two FY's for possible inactivation or if charges have been misapplied.
• Review all CDM lines items with Usage is reasonable and accurately stated.

6. Perform Status Indicator Code (SIC) evaluation:

• Identify all non-reimbursable items in CDM with SIC "B, C, E, M., N, Y"
• Review each non-reimbursable SIC code for possible CPT/HCPC code replacement or removal of CPT/HCPC code.

7. Perform basic Pricing evaluation:

• Identify and review all zero Priced items.
• Identify and review all Prices less than established CMS (Medicare & Medicaid) fee schedules and APC Addendums A & B.
• Identify all like items, by description and/or CPT/HCPC codes with different prices.
• Review all markup or cost methods used hospital as by applied to each CDM item and if accurately applied for Pricing
• Review is all Revenue Coded 999 items are zero priced.

8. Perform RAC Alert evaluation:

• Review every RAC Alert as identified by editor.
• Discuss what RAC Alert means and how to be prepared

9. Interview department managers to validate the accurate reflection of services currently rendered by their department through industry standard models.

10. Provide guidance in implementing a daily charge reconciliation program with ongoing chart reviews.

11. Identify any departments where an in-depth review for lost revenue opportunities exists.

12. Compare order entry systems and all sub-systems in relation to the CDM, to ensure accuracy and make recommendations for correction of descriptions as needed.

13. Provide hospital departments with reimbursement education assistance for procedural modeling and coding accuracy.

14. Train hospital department directors on the importance of accurate CDM maintenance and the regulations they must follow to stay in compliance with all Third Party Intermediaries.

15. Establish a process for reviewing and maintaining the CDM on an ongoing basis.

14. Provide a written report at the end of engagement with recommendations for improving the ongoing integrity and efficiency of the hospital's charging system with full documentation to support every recommendation.

MedCompliance Services, Inc.
Jessy Huebner, MAT, CHFP, CEO
800 West Avenue #1001
Miami Beach, Florida 33139

Number of years offering CDM clean-up/auditing and staff education:

• Thirty nine years

Management Team:

• On and off-site auditing and training personally provided by Jessy Huebner, MAT, CHFP with over one thousand hospital audits performed by him and his research and support staff.

Education/Training:

• Eighty percent of the onsite time is dedicated to education/training while resolving issues found in the CDM. From the basic methodology of how understand CMS Rules and Regulations to how to use the editors owned and created by MedCompliance Services that are used to perform this review: "The Healthcare Financial and RAC Editor", "The Information Integrity Editor" and "The Healthcare Department Modeler". The worksheets from these three editors give vast amounts of information for each departmental director to use on a day to day basis.

Difference our service provides from all others:

• The services offered by MedCompliance Services differ from all other services because MedCompliance uses its own copy written editors that merges files and reviews not only the CDM but also Order Entry and all Subsystems such as Epic, Siemens, McKesson, Meditech, Pyxis, GE and Cerner. Also within the financial editor is a pricing model for a basic pricing review with impact reflected as changes are made. MedCompliance Services offers ongoing maintenance for problem solving and full CDM audits as often as client desires plus unlimited e-mail and telephone support at no additional cost during the terms of the contract.

How we keep abreast with government rules and regulations:

• Daily list serve emails are received of updates and web sites are checked for updates by AMA, AHA, CMS, BC/BS and Medicaid/MediCal. These updates are merged into the MedCompliance Editors.

1. On-site work plan

• Review is performed on-site at hospital
• Time required on site for interviews is 2, 3, 4 or more days depending on size of facility and size of CDM
• Each departmental director will be assigned a time, such as this 3 day on site example:

CDM Departmental Meetings

Day 1

• 8:00 - 9:00 Introduction Session
• 9:00 - 10:30 Pharmacy
• 10:30 - 11:30 Nursing
• 11:30 - 12:30 Lunch
• 12:30 - 2:00 Lab
• 2:00 - 3:00 Cardiology
• 3:30 - 5:00 Central Supply

Day 2

• 8:00 - 9:00 Dietary
• 9:00 - 10:30 Radiology
• 10:30 - 11:30 Oncology
• 11:30 - 12:30 Lunch
• 12:30 - 2:00 Pulmonary/Respiratory
• 2:00 - 3:30 ER
• 3:30 - 5:00 PT, OT, ST

Day 3

• 8:00 - 9:30 OR, Anesthesia & RR
• 9:30 - 10:30 Clinics
• 10:30 - 11:30 Pulmonary/Respiratory
• 11:30 - 12:30 Lunch
• 12:30 - 2:00 Cardiac Cath Lab
• 2:00 - 4:00 Wrap Up session with Administration of findings

Critical factor is having all department directors attend their appointed times for interview.

Interviews include training on editor worksheets, clean up department CDM, and resolve reimbursement issue and to insure CDM is kept clean and in compliance.

2. Off-site work plan

• Review is performed off-site with Webex meetings for each department director and administration.
• Webex is scheduled in accordance with directors availability
• No travel expenses are incurred

3. Average lead time is two weeks to prepare for review and two weeks after on site review is completed to give final recommendation report.

4. The following files in Excel format:

• CDM
  • Column A - Dept #
  • Column B - Item #
  • Column C - CDM Description
  • Column D - Revenue Code
  • Column E - CPT/HCPC Code
  • Column F - Price
  • Column G - Modifier (if not attached to CPT/HCPC code)

• Usage by FY (need 2 FY's if available)
  • Column A - Item #
  • Column B - IP Usage each FY
  • Column C - OP Usage each FY

• Department Listing - (in Excel format)
  • Column A - Department #
  • Column B - Department Title

• Order Entry System - (in Excel format)
  • Column A - Item #
  • Column B - Order Entry Description

• Each Sub System - (in Excel format)
  • Column A - Item #
  • Column B - Sub System Description

5. Resources needed include the following:

• A room large enough for six or more people.
• Screen for projection.
• Flip chart or black board with markers.
• Internet connection.
• Telephone.

The hours of operation are: Monday - Friday 8AM to 8PM EST

1. To maintain the integrity and accuracy of the MedCompliance Editors, we download updates/changes by CMS (Medicare & Medicaid) and AMA as they are released. Each editor is a moving target of changing data with a full time staff to maintain that it is kept current. Programmers are constantly adding new features as requested by our existing clients at no additional expenses to the client.

2. We track performance by continually running the hospitals data through the editor for any changes that need correction to ensure each claim is not getting incorrect information that will cause billing delays and/or rejections through the hospital backend scrubber.

3. Performance measures are reflected in run reports to enable each client to track their improvement.

4. We have a high customer satisfaction by responding to each and every question and/or request in a timely manner not to exceed 24 hours.

5. We do not have a written level agreement outside our standard contract because we offer only one level "Ensure client satisfaction by delivering the quality of service that our clients expect"

Hospitals on a daily basis face a number of important CDM issues that need to be addressed before adverse situations occur. Management should consider making decisions that will help ensure proper and consistent charging and billing practices, and will help take advantage of associated revenue / reimbursement enhancement opportunities.

Proper and consistent maintenance of the Order Entry, each Subsystem and CDM, while time consuming, is an integral part of the organization's continued financial viability. The on-going code changes made by various payers, along with the impact CDM modifications have on reimbursement, make timely CDM maintenance a priority. It is strongly recommended establishing proper oversight and control and should also have a mechanism to audit and maintain the CDM.

If you have questions, please contact:

MedCompliance Services, Inc.
Jessy Huebner, MAT, CHFP, CEO
800 West Avenue #1001
Miami Beach, Florida 33139