Avoid Compliance Risks with Charge Description Master Reviews
The American Association of Procedural Coders (AAPC) has stated, “Approximately 75 percent of outpatient services are driven by the CDM”[1] The Charge Description Master (CDM) populates the claim form with these services, supplies and pharmaceuticals. The compliance risks to your organization are immeasurable if the CDM is incorrect in any way.
Having provided CDM Reviews for more than 20 years, we continually see this one area is not a high priority and is continually neglected. It is often an afterthought for most organizations, making it a significant risk for submitting potentially false claims without even knowing, on a daily basis, with high volumes.
Ideally, every provider should be reviewing and updating their CDM on a quarterly basis. The CDM should never be reviewed and updated less than annually. Additionally, external, independent reviews should be conducted regularly to validate revisions are being implemented comprehensively and correctly. Due to the rapidly changing code sets as well as billing and reimbursement rules, properly reviewing and updating your CDM less than annually, can lead to significant loss in revenue in addition to dramatic increases in denials and compliance risk. However, when asked, many providers have indicated they have not conducted an external review of their CDM for 8-10 years, on average.
What we see on a recurring basis. A few examples include:
Hard coded modifiers attached to codes that will bypass Medicare edits
Inaccurate and completeness of the service (CPT/HCPCS) descriptions within the CDM
Updated or new codes that are simply not included in the CDM
Deleted codes that are still reported but no longer valid
Auto populating the CDM for a given service, supply or pharmaceutical with multiple units rather than one, without first validating the medical record
Incorrect/invalid revenue code – CPT/HCPCS code combinations
If even one of these codes is incorrect - of the thousands in your CDM – imagine the level of risk to your organization at this moment?
We have a team of CDM experts that includes certified coders as well as individuals who worked for a Medicare Fiscal Intermediary, who personally review each line item within your CDM. We utilize a team approach to ensure you are provided with accurate, detailed recommendations to ensure appropriate charge capture and reimbursement while reducing denials and compliance risk.
[1] American Academy of Professional Coders’ “Certified Outpatient Coder: COC™ 2015 Study Guide” Page 41