Charge description master can be a difficult and complicated process,
but by knowing the most common CDM difficulties — and knowing how to
deal with them you can ensure a smoother process, better compliance, and
more reimbursement.
1. Right Code, Wrong Place
We have all been through this. There are a handful of frustrating codes that we always mix up. However, when you factor the charge description master (CDM) into the mix, a few incorrect codes can quickly add up to big money — and possibly major compliance errors and resultant audit attacks.
Another common problem is incorrectly billing for outpatient services that your facility's physicians provides in multiple locations. In case your hospital provides services for the same patient in several different parts of the facility, you must make a note of where each service was performed and attach it to the appropriate CPT® billing code for that particular department.
2. Linking The CPT® and HCPCS Codes Incorrectly
While you always stay alert to the links between incorrect (or medically unnecessary) diagnoses and procedures, but keep in mind that some situations actually call for you to link some HCPCS codes with the CPT® codes.
3. Mysterious Mistakes in Services or Supplies
Always let the charge description master (CDM) coordinator know as soon as possible about the change in the cost of services and supplies. Sometimes the coordinator doesn't find out the change for a long time, and may only discover the change during a revenue code edit.
To have an up-to-date chargemaster, it is extremely important that you keep the communication lines open and keep learning about the new procedures and code changes. The key here is to implement the new codes as soon as they are released, and get them into the CDM.
4. Not Documenting Medical Necessity
This is another common yet a much problematic error. This can be especially a difficulty when the physician orders some specific tests. In such cases, the costs can be high and the medical-necessity requirements can be very specific.
Observation is yet another place where a number of practices lose a lot of revenue because of incomplete or incorrect medical-necessity documentation.
5. Not Cleaning Regularly
You should give your chargemaster a major update at least once every year. You should also update the chargemaster every three months to keep current with the CPT® code changes and National Correct Coding Initiative (NCCI) edits. In addition, you should examine closely the new CMS regulations to see what you need to change or update. This may include new services, supplies, and physician's fee schedule revisions. Also perform a detailed annual review of the services performed in each department regularly.
However, when "cleaning out" the unused CPT® codes, you should not delete them completely. You should instead make them inactive as you may need them in future to provide long-term financial information.
1. Right Code, Wrong Place
We have all been through this. There are a handful of frustrating codes that we always mix up. However, when you factor the charge description master (CDM) into the mix, a few incorrect codes can quickly add up to big money — and possibly major compliance errors and resultant audit attacks.
Another common problem is incorrectly billing for outpatient services that your facility's physicians provides in multiple locations. In case your hospital provides services for the same patient in several different parts of the facility, you must make a note of where each service was performed and attach it to the appropriate CPT® billing code for that particular department.
2. Linking The CPT® and HCPCS Codes Incorrectly
While you always stay alert to the links between incorrect (or medically unnecessary) diagnoses and procedures, but keep in mind that some situations actually call for you to link some HCPCS codes with the CPT® codes.
3. Mysterious Mistakes in Services or Supplies
Always let the charge description master (CDM) coordinator know as soon as possible about the change in the cost of services and supplies. Sometimes the coordinator doesn't find out the change for a long time, and may only discover the change during a revenue code edit.
To have an up-to-date chargemaster, it is extremely important that you keep the communication lines open and keep learning about the new procedures and code changes. The key here is to implement the new codes as soon as they are released, and get them into the CDM.
4. Not Documenting Medical Necessity
This is another common yet a much problematic error. This can be especially a difficulty when the physician orders some specific tests. In such cases, the costs can be high and the medical-necessity requirements can be very specific.
Observation is yet another place where a number of practices lose a lot of revenue because of incomplete or incorrect medical-necessity documentation.
5. Not Cleaning Regularly
You should give your chargemaster a major update at least once every year. You should also update the chargemaster every three months to keep current with the CPT® code changes and National Correct Coding Initiative (NCCI) edits. In addition, you should examine closely the new CMS regulations to see what you need to change or update. This may include new services, supplies, and physician's fee schedule revisions. Also perform a detailed annual review of the services performed in each department regularly.
However, when "cleaning out" the unused CPT® codes, you should not delete them completely. You should instead make them inactive as you may need them in future to provide long-term financial information.
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