cdm review and coding update your facility today

CDM Review and Coding Update

Your Facility

Today

Is it time to have your CDM reviewed and reviewing the existing associated

processes?

Why Conduct a CDM Review?

Maximize Revenue Opportunities. Ensure your CDM is compliant and facility

adheres to proper billing practices To keep up with the multiple coding

requirement from all payors. Reduce the number of days in receivables. Good to have an external point of view of

your current CDM maintenance approach.

Why Conduct a CDM Review?

Make sure the charging philosophies behind the CDM are current with marketplace.

Process is self funding. Make sure billings are going out without

delays. Reducing whenever possible the level of

manual intervention of processing claims. Review key indicators to make sure there are

no work flow issues.

Why do CDM Review (cont)?

The CDM Review looks at your price file from a multidimensional prospective.• General Composition of file

• Compliance prospective

• Revenue Opportunities

• Associated checks and balance processes Systematically Reviewing Problem Areas. Provide you with a road map to address

problems.

Importance of properly maintaining your CDM

Possible issues associated with untimely updates:

• Claim Denials / Delay in Payments

• Claims not Passing Edits / Manual Intervention

• Coding Updates: AMA & CMS

• A noncompliant CDM

• Untimely Management of Problem Areas

• Monitoring of Prices Below APC Rates

• Not maximizing revenues

• Assurance of Proper Billing Practices Occurring


The Components


There are multiple components to our Comprehensive CDM Review process:• Pre engagement data needs

• CDM’s General Characteristics Evaluation

• Kick Off Meeting (Optional on site visit)

• Initial Review of CDM ( Off site)

• Departmental Interviews (On site visit)

• Report Presentation (On site visit)

• Implementation Check (Off site)


First Component:

Pre Engagement Data Needs


Pre Engagement Data Needs• A list of departmental manages and phone directory.

• Require a complete chart of accounts and key to the CDM.

• Will need an electronic download of your CDM.

• Will require associated usage information for a 12 month period.

• Compile information into MedChex’s our automated tool used during the review.


Second Component:

CDM’s General Characteristics Evaluation


General Characteristics Evaluation• Load the electronic CDM file into MedChex.

• Obtain from facility coding guidelines to follow.

• Create a baseline matrix of existing CDM and usage information.

• Generate the appropriate set of reports to be discussed and distributed prior to site visit.

• Ascertain from the facility who the project liaison is.

• Develop a work plan and agree on timetables for engagement.


Third Component:

Kick off Meeting


Kick Off Meeting• Define project liaison responsibilities.

• Review engagement objectives.

• Finalize site visit dates.

• Provide preliminary reports to department for action prior to site visit.


Fourth Component:

Phase I CDM Analysis


Key Elements• Determine if there are any deleted HCPCS codes in the file.

• Identify any questionable line items for review with dept.

• Determine if there are any invalid codes.

• Identify any resident problematic charges in the CDM.

• Ascertain if there are like procedures with variable prices in the price file

• Review your overall pricing strategies for consistency and

determine if supportable.


Key Elements (cont)

• Analysis of procedures and their relationship to APC and CLAB schedules.

• Determine the level of S&I codes populating the imaging areas and their usage patterns.

• Review the a number of key indicators in the Emergency Department and their usage patterns.

• Review the overall structure and inconsistencies of charges in the Surgery suite.

• Determine if implants have been properly identified.

• Review mark up formulas and round off strategies for supplies.


Fifth Component:

Fact Finding Site Visit

CDM Review and Coding Update Departmental Interviews and Open Issue

Clarification.• Review with manager in depth each cost center and

their charge procedures.• Go over all key indicators• Inactivate any line item not being used• Add procedures/services missing from CDM• Clarify specific items that are questionable• Get clarification regarding charging procedures and

charge protocols in place• Provide education to the managers regarding CDM

management


Six Component:

Final Report Presentation


Final Report Presentation• Present engagement final report

• Discuss engagement objectives

• Present missed revenue opportunities

• Identify compliance related issues found

• Present departmental specific findings

• Recommend action steps to be taken

• Set estimated time frame to make changes to CDM

• Schedule time for implementation check


Seventh Component:

Implementation Check


Implementation Check• Request a new download of CDM

• Compare new file with the final report

• Measure the level of changes made to the new file

• Discuss with project liaison recommendation made not implemented

• Make final implementation report to the CFO

End of Presentation

Healthcare Concepts appreciates

your time and we look forward to

working with you in the near future.

cdm review and coding update your facility today

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