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Strategies for Revenue Cycle Management. Focusing on the Charge Description Master. Module Two Supplies and Equipment. What is the CDM?. The CDM is a list of supplies and services with corresponding charges for each of those items.

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Strategies for Revenue Cycle Management

Focusing on the Charge Description Master

Module Two

Supplies and Equipment

what is the cdm
What is the CDM?
  • The CDM is a list of supplies and services with corresponding charges for each of those items.
  • Items are grouped together by the departments and nursing units of the healthcare facility.
specific issues
Specific Issues
  • Routine Supplies
    • Not separately billable
  • Ancillary Medical Supplies
    • Separately billable
  • Equipment
  • Durable Medical Equipment
  • Prosthetics/Orthotics
routine supplies
Routine Supplies
  • Not specifically ordered by a physician AND are normally expected to be available.
  • Allowed as “covered” services
    • Cost can be reported in the hospital cost report
    • Usually are NOT separately billed on the UB
slide5

Not Separately Billable Supplies

  • Charges are usually included in the room cost or the procedure cost.
  • No specific hospital regulations regarding separate billing
    • Medicare Fraud and Abuse look to Skilled Nursing Facility regulations
    • Also refer to http://www.cms.hhs.gov/providers/default.asp
not separately billable supplies
Not Separately Billable Supplies
  • Items furnished routinely and relatively uniformly to all patients.
    • Patient gowns
    • Paper tissues
    • Water pitchers
    • Basins
    • Bed pans
    • Deodorants
    • Mouthwashes
not separately billable supplies1
Not Separately Billable Supplies
  • Items stocked at nursing stations or on the floor in gross supply and distributed in small quantities
    • Alcohol
    • Applicators
    • Cotton Balls
    • Band-Aids
    • Aspirin (non-legend drugs)
    • Suppositories
supplies in the or
Supplies in the OR
  • Do not bill for drapes, gowns, linens etc.
  • Do not bill for instruments used such as scopes or lasers.
  • Do not bill for reusable trays.
  • Do not bill for oxygen or pulse oximetry.
separately billable supplies
Separately Billable Supplies
  • Services are considered as ancillary AND therefore, are separately billable.
  • Following conditions must be met
    • Directly identifiable to a specific patient
    • Furnished at the direction of a physician because of specific medical needs
    • Not reusable or representing a cost for preparation
    • Not routinely furnished to all patients within a setting
    • Not a reusable item
    • Meet a specific medical need
    • Charged to Medicare and non-Medicare patients similarly
    • Commonly charged as ancillary by providers within the State
separately billable supplies1
Separately Billable Supplies
  • Disposable and separately billable items should always be charged.
  • Do not use estimates
  • Ancillary charges should be directly identifiable to a specific patient.
equipment
Equipment
  • Reusable equipment is considered as capital cost.
  • Equipment charge should be included in facility or room charge of the department.
  • Equipment should not be separately charged to the patient.
equipment1
Equipment
  • Equipment commonly available to patients in a particular setting is routine and not separately billable.
  • Supplies routinely used with the equipment is also not separately billable, unless considered a disposable supply item that meets ancillary criteria.
equipment2
Equipment
  • Examples of not separately billable equipment
    • Cardiac monitors
    • OR lights
    • Traction devices
    • Specialty beds
    • Suction devices
durable medical equipment
Durable Medical Equipment
  • Hospital must have a DME supplier number
  • Generally reusable and suited for home use
  • Medicare will pay separately.
  • Examples: Wheelchairs, crutches, braces
prosthetics orthotics
Prosthetics / Orthotics
  • Prosthetics / Orthotics are billed on the UB-92 to the Fiscal Intermediary
  • Use revenue code 274
  • Use appropriate HCPCS code for the device
  • Paid under the fee schedule on bill types 12X (inpatient) or 13X (outpatient)
prosthetics orthotics1
Prosthetics / Orthotics
  • Certain HCPCS codes are considered supplies and should be billed under the 272 revenue code.
    • A4310-A4330, A4338-A4359, A5102-A5114
  • A5119-A5131 will not be paid unless submitted with ostomy related procedures
prosthetics orthotics2
Prosthetics / Orthotics
  • Generic names cause difficulty in assigning HCPCS codes for billing
    • Identify item on shelf
    • Locate vendor and item number
    • Look in vendor catalog
    • Most vendors now publish the HCPCS for each item in their catalog
summary
Summary
  • If an item is routinely used for all patients in a certain setting, the item should not be separately billed, but included in the facility/room or procedure charge.
  • If the item is a bulk supply item that is used in small quantities, such as cotton balls, do not separately bill.
summary1
Summary
  • Department managers should identify all supplies used in their respective areas / procedures.
    • Determine which are routine and which are ancillary
    • Determine how these are treated in the CDM
    • Verify detail bills to the medical record to insure all charges are accurately reported.
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Strategies for Revenue Cycle Management

Focusing on the Charge Description Master

Module Two: Supplies and Equipment

If you have any questions or concerns regarding this course, please contact Mary Askew

at [email protected]

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