• Comparative charge, APC payment and fee data. Compare your charges with Medicare reimbursement and price and cost data for hospital outpatient services in your core-based statistical area (CBSA). Identify potential additional revenue for new and existing services, and set reasonable and justifiable charges for procedures within your selected market.
• Audit trail tracking and reporting. Provides a detailed accounting of all changes made to the CDM database by identifying any field that has been modified with a “before and after” data display. Output reports can be run from the audit trail database to help the user perform additional queries to identify specific line items or issues that were changed.
• Flexible reporting. Users may run Issue Reports, Impact Reports and Status Reports in a variety of output formats – CVS, HTML and PDF. Issue Reports provide benchmarking tools to identify line items with coding and billing errors, revenue and compliance problems, and monitor corrections, changes and results. Impact Reports identify missing HCPCS/CPT® coded line items and services for 38 clinical departments. Charge Comparison Reports allow the user to run reports of Medicare reimbursement compared with the hospital charge or aggregated CBSA charges compared with the hospital charge amount.
• “What if?” charge adjustments. Allows the user to adjust charge amounts by a set percentage or by a specific dollar amount and have it applied to the entire CDM or to a specific ancillary department.
• CCI unbundled edits and OCE edits (including device code pairs) are flagged to indicate which CPT®/HCPCS codes are billed together. Highlights hospital outpatient CCI edits, OCE edits and device code relationships. This will help you know which codes can/should be billed together, which are mutually exclusive and which require a modifier if supported by medical documentation.
• "Code Detail" page. Provides a centralized source for all of your CDM coding tools and information. It includes full code descriptions, lay descriptions and anatomical images for the complex procedures, outpatient code edits and Medicare Pub. 100 reference information. Maintain chargemaster accuracy at a detail level.
• Best practices. Identify CPT® and HCPCS Level II codes that may be missing from your CDM by clinical department. Once identified, use this tool to determine the revenue impact of adding charges for unrecognized procedures or revising code assignments for services already being performed.
• Robust code search functionality. Simplifies keyword and code searches across CPT®, HCPCS Level II and revenue codes and integrates results.
• Uses the latest codes, outpatient edits, payment indicators and revenue code logic. Helps you minimize denials and improve revenue cycle performance. Cross-references automatically identify which code(s) to use to replace a deleted code.
• Auto-analysis function. Identifies more than 12 CDM compliance problems and offers solutions on a line-by-line basis. Eliminate rarely-used and inaccurate codes and identify non-billable codes and codes subject to editing under OCE. Aids in chargemaster compliance with CMS coding, billing and coverage rules.
• Set up new codes with appropriate revenue codes, meaningful short descriptions and charge amounts. Eliminate the guesswork when setting up new codes or procedures.
• Analyze and compare CDM data more effectively. Instantly identify all codes that are not billable to Medicare under OPPS.
• Corrects mismatched CPT®/HCPCS codes and revenue codes. Ensures CDM accuracy at detail level.
• Manage outpatient reimbursement. Uses all outpatient payment methodologies (APCs, fee schedules, cost) with the charge analysis function to help you set the correct charge for services.