1. The functions of the Charge Description Master (CDM) include producing an ite
ID: 127264 • Letter: 1
Question
1. The functions of the Charge Description Master (CDM) include producing an itemized statement of services received by a patient during a healthcare encounter, assigning charges to services and supplies, monitoring the cost of care, and providing cost accounting data to financial systems. Most errors are not the result of inaccurate CDM but rather a disconnected charging process. As the CFO of Healthcare Hospital, you are tasked with finding ways to prevent the following areas of common charging and coding errors. Address the following situations in your facility.
2. The following table is a sample of a section of the CDM for your hospital. After and audit you determine that for inpatient procedures, coders use ICD-10-PCS codes but the CDM uses CPT or HCPCS codes to determine charges for procedures. There is no link in the CDM between CPT or HCPCS codes and ICD-10-PCS codes. What should you do to correct this?
b. The billing department employees do not have systems in place to check for inaccurate charges. What procedures should be put in place to correct this?
c. The laboratory department CPT codes for tests are hard-coded into the laboratory electronic system and sent directly to the claim form, by-passing the CDM. What should be done to correct this?
3. Managing the Revenue cycle process: Explain why revenue cycle management is important and what the role for HIM professionals is in the process. Use a minimum of 3 sentences.
DEPT REVENUE MEDICAID DESCRIPTION ITEM NUMBER NUMBER 791002 481 CORONARY ARTERY DILATION INJECTION, CARDIAC CATH NURSING FAC CARE SUBSEQ HOME VISIT NEW PATIENT 92982 92982TC 761 761 $1,550.00 DB00.4601 481 93540TC 0800.4601 91000 761001 220.00 93540 9307 636 761 $75.00 0800.4601 761002 99341 56 610 761 |761 |761 0800 4601 800 4601 800 46 01 $ 80.00 |REPAIR EYELID DEFECT |REPAIR EYELID DEFECT REMOVAL OF KIDNEY STONE |DECALCIFY TISSUE CHROMOSOME COUNT ADDITIONAL ASSAY OF FREE THYROXIE ASSAY OF THYROID ACTIVITY ASSAY THYROID STIM HORMONE 751003 810003 810004 | $ 110 CO|57915 | S 55000 |67916 0080 |636 |272 [7610 r610 272 7610 S 390.00 761 1761 D800,4501 D900 4001 10050 $2.065.00 88311 8285 610 610 10061 10072 810080 791004 761 761 761 761 275.00 $159.00 $7,064.00 650.00 64439 34442 84443 272 622 272 272 610 610 7510 0800 4601 0800.4601 0800 4601 0800.4601Explanation / Answer
ANSWER (1)
Following are the way through which a CDM can prevent the coding and charging orders :
A. production of an itemized statement.
B. Assigning of the charges of inpatient claim.
C. Assigning charges ,codes and description on the outpatient claim.
D. Regular statistic analysis and tracking of record.
E. Monitoring of the cost and care of patients.
F. providing cost according to data to financial systems.
ANSWER (2)
(a) The best way to correct this mismatch is as follows.
1. Comparing ICD 10 description to the CDM CPT description.
2. Regular charge to charge audit should be promoted and performed on the top procedures and identification of cahrge entry omissions
3. Findings should be shared with clinical staff.
4. To enforce consistency a charging policy should be created and followed.
5. Assigning of one charge specialist to audit charges.
answer (b)
To check for inaccurate charging ordera following procedure should be followed.
1. The bill inception :- At the time of admission ask any member of medical team to ensure that yku understand what care is being given and why. Listen carefully and correct the information that is inaccurate. always remeber that radiologists and anesthsiologists usually bill seprately for their survices
2. At the time of surgery if possible famiky members or friends should be present to verifu insurance and ask about treatments and it is wise to keep a record of everuthing.
3.During inpatient stay:- during inpatient stay a friend or family member should keep a seprate log of all the sevices and patient's chart .
4.At the time of discharge when bill arrives request detailed item billing check if there is any duplicate billing error.
Importance of revenue management cycle
(A) A well designed revenue cycle management system tracks patient care simplifies the billing and collection cycle, by registering,appointing,scheduling and processinh the payment.
(B) It fills the gap between business and clinical sides of health care.
(C) It hepls the health care providers for preserving and managing patients billing records.
(D) Revenue cycle managemenf helps to save helath care practices time.
(E) It allws health care staff to enter all the information required for clamps processing and avoid resubmission of clamps
ROLE OF HIM
HIM professional play a pivotal role in health care RCM(revenue cycle management) by helping to avoid penalties improve patient outcomes and meet compliance.
They also ensure proper reimbursement .
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