Chargemaster (CDM) Reviews
The foundation for the revenue cycle is the Charge Description Master (“chargemaster” or CDM)—much of the information appearing on patient bills and insurance claims comes directly from this internal database. Therefore, its integrity is vital to ensuring that patient bills are accurate (a key customer service issue), that revenue is optimized, and that billing is compliant with Medicare and third-party payer rules. Unfortunately, maintaining this complex data file is a challenging task. Regulatory updates occur at least quarterly, and frequent service changes create the potential for sometimes daily interventions to the chargemaster. Many hospitals, particularly smaller facilities (rural and critical access hospitals), are challenged by this complexity.
An annual external review of the chargemaster is the best way to support accountability for this important operational process. Wipfli provides the full continuum of chargemaster services, from performing this assessment to educating and mentoring your staff on ongoing chargemaster maintenance.
Areas of Expertise
- Current CMS regulations related to billing for hospital services
- CPT and HCPCS coding
- Professional (CMS 1500) and technical (UB-04) data elements and their relationship to the chargemaster
- Bundled/unbundled services
- Cost reports and their relationship to the chargemaster
- Comprehensive software to support chargemaster reviews
Types of Services
- Comprehensive chargemaster review with identification of recommended changes
- On-site meetings with departments to identify services provided but not currently in the chargemaster, creating lost billing opportunities
- Detailed reports that provide recommendations by department to enhance compliance, chargemaster accuracy, and departmental ownership
- New departmental charge forms to enhance billing compliance, completeness, and accuracy
- Follow-up implementation support to ensure all required changes have been made to the chargemaster
- Identification of areas in need of charge policy revisions
- Chart reviews to compare billing to documentation to identify:
- Revenue opportunities
- Compliance exposure
- Ongoing ad hoc billing research and support
Featured Expertise