CDM Re-Engineering/Rebasing

Changes in reimbursement policies have necessitated a change in the structure and functionality of certain items in the CDM. In addition, many providers have not thoroughly analyzed their pricing structure and may be missing revenue opportunities by not standardizing their charging practices. Many different payers have varying policies in how they want charges presented to them for reimbursement. These changes dramatically affect the way the CDM is structured and how it is used in billing practices. In order to receive the maximum financial benefit a full review and reorganization of the charges in the CDM must be performed.

Our specialists have been trained with and have experience recognizing revenue enhancement opportunities in your CDM. Through are extensive knowledge and the use of MedChex CDM Management software we will be able to quickly analyze and assess your pricing policies and mark-up formulas and recommend a comprehensive strategy for increasing your reimbursement through effective CDM management. We will also provide you with the back up documentation and support you will need to make educated decisions concerning the bundling or un-bundling of charges in your CDM.

Re-engineering helps providers realize missed revenue opportunities by maximizing their reimbursement potential and improves cash flow by reducing re-billing activity. A complete review of your pricing policies and practices will ensure that all departments adhere to the same pricing structure. This allows the provider to carefully review the financial performance of each department by standardizing charging policies. By re-organizing the charges in their CDM, providers will be given the opportunity to realize additional revenue for procedures that they are currently performing and not being reimbursed for. This can have an immediate financial impact on the organization.

Our specialists will provide all the necessary back up documentation that justifies any and all changes made to the charging practices of the provider. We work with providers in identifying sources of missed income and potential lost revenue. In addition to providing consultation and documentation of the development of corporate pricing guidelines our staff will provide detailed reports outlining any changes or recommendations to pricing formulas and the bundling/un-bundling of selected items in your CDM. The reports included in this service offering consist of:

• Markup Formula Pricing Comparison
• CDM Changes Report
• Items to be Re-based Report
• Departmental Pricing Guidelines 
• Departmental Charge Sheets

Presentations will be made to staff on our recommendations to which may include the modifications of departmental procedures and charge sheets. This comprehensive analysis of charging practices and supporting documentation protect the provider from costly re-billing activity and missed reimbursement revenue.

Providers are asked to provide their CDM information in accordance with our easy to follow download requirements. Once we have received the data it will then be loaded into MedChex CDM Management Software where our specialists will begin the review of the CDM. Our specialists will travel on site to the provider and conduct interviews with staff to determine the appropriate pricing policy and discuss departmental procedures. We will then apply the pricing policy to the data which we have received and make recommendations for changing or modifying items in the CDM. Our specialists will then present our findings to staff and assist in implementing the changes.