Chargemaster (CDM) Reviews

    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

    Jeanne Chapdelaine

    With more than 25 years of health care experience, Jeanne Chapdelaine is the director of Wipfli’s revenue integrity and optimization service line. She coordinates service delivery to health care clients for their revenue capture processes, coding and documentation, business office functions, service pricing, reimbursement, regulatory compliance, and third-party payer contracts. Jeanne helps health care organizations by focusing on the issues that will have the greatest financial impact.

     

    Jane Jerzak, CPA, RN

    Jane Jerzak has a unique dichotomy in that she has expertise as both a certified public accountant and a registered nurse. She has extensive clinical reimbursement and strategic experience, enabling her to be a catalyst for positive organizational change in our current dynamic health care marketplace.