Strategies for Revenue Cycle Management
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Strategies for Revenue Cycle Management. Module One. Focusing on the Charge Description Master. CDM Reviews. Traditional Acute Care Hospital (PPS Hospital) OPPS reimbursement methodology Critical Access Hospital (CAH) Cost-based reimbursement methodology. What is the CDM?.

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Module one

Strategies for Revenue Cycle Management

Module One

Focusing on the Charge Description Master


Cdm reviews

CDM Reviews

  • Traditional Acute Care Hospital (PPS Hospital)

    • OPPS reimbursement methodology

  • Critical Access Hospital (CAH)

    • Cost-based reimbursement methodology


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.


Elements of the cdm

Elements of the CDM

  • Charge Code

    • Numerical identification of the service or supply.

  • Item Description

    • Actual name of the service or supply.

  • Revenue Code

    • Three-digit number used for Medicare billing

  • CPT/HCPCS Code

    • CPT – 5 digit number used for Medicare billing

    • HCPCS – alpha numeric code used for Medicare billing

  • Insurance Mapping Code

    • Allows a healthcare facility to hold more than one CPT/HCPCS code per CDM item.

  • Charge

    • Dollar amounts owed by patients to the facility for specific services or supplies.

  • Activity Date/Status

    • Indicates the most recent activity of an item.


Where and what type of service was performed

Where and what type of service was performed?

450 Emergency Room Level 3 99283 05/01/05 1 150 00

637 Self-Administered Drugs 05/01/05 1 15 00

Revenue Codes


Fl 42 revenue code

FL 42 – Revenue Code

  • Required for Medicare billing

  • A code which identifies the specific type of service being billed

  • Each line item charge billed should be assigned a revenue code

  • List in ascending order

Reimbursement


Examples of revenue codes

Examples of Revenue Codes

  • 250 – Drugs

  • 270 – Supplies

  • 300 – Laboratory

  • 360 – Operating Room

  • 450 – Emergency Room

  • 637 – Self-administered drugs


Revenue codes and reimbursement

Revenue Codes and Reimbursement

  • Cost Reporting

  • Non-covered Services


Cost reporting

Cost Reporting

  • Three digit revenue codes reported on each claim form.

  • Code indicates hospital area providing service.

  • Charges for each area are summarized on governmental reports.

    • PSR – Medicare summary

    • HSR – Medicaid summary


Hospital reimbursement

Hospital Reimbursement

  • PPS Hospital

    • Revenue codes impact future DRG inpatient payment amounts and APC outpatient payment rates.

  • Critical Access Hospital

    • Revenue codes directly affect current year’s reimbursement.


Revenue code resources

Revenue Code Resources

  • UB-92 Editor published by Ingenix

  • Fiscal Intermediary

  • Various other web-sites


Billing information form locators

Billing Information Form Locators

450 Emergency Room Level 3 99283 05/01/05 1 150 00

637 Self-Administered Drugs 05/01/05 1 15 00

How many?

How much?

Not allowed

What?

When?


Fl 44 hcpcs rates

FL 44 – HCPCS/Rates

  • Conditional for Medicare billing

  • Contains the Healthcare Common Procedure Coding System (HCPCS) applicable to ancillary services for outpatient claims

71020


Critical access highlights

Critical Access Highlights


More critical access highlights

More Critical Access Highlights


Cah cdm review

CAH – CDM Review

  • Update CDMs yearly

  • Review for compliance and reimbursement

  • Distribute Medicare Bulletins to all revenue units

  • Analyze financial impacts of change


Module one

Strategies for Revenue Cycle Management

Module One

Focusing on the Charge Description Master

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

at [email protected]


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