.: SunStone Consulting | Healthcare Reimbursement & Regulatory Solutions :.

You operate in a complicated financial and regulatory environment that demands complete and accurate billing. As the primary charging tool, the Charge Description Master (CDM) requires constant monitoring and maintenance. Date errors, incorrect charge structures, and non-covered charges expose hospitals to Medicare and Medicaid compliance risk as well as third party contractual exposure.

Dealing with challenging issues requires in-depth knowledge of Medicare reimbursement and regulatory principles, HCPCS/CPT coding guidelines, hospital charging processes and clinical operations.

At SunStone, our nationally recognized experts thoroughly understand governmental guidelines and regulations that relate to the charge process.

The SunStone Process

Line-by-line review of the entire CDM, or specific ancillary areas
Evaluate order entry and billing CDMs
On-site meetings with each ancillary manager
Evaluate HCPCS/CPT codes according to payer guidelines and regulations
Map revenue codes to HCPCS/CPT codes for accurate reimbursement
Identify duplicate, unused and invalid HCPCS/CPT codes
Review appropriateness of hard-coded modifiers
Review departmental order-entry and charge sheets
Assess charge structure
Identify appropriate bundling of services
Analyze claims to ensure effective CDM utilization

Our thorough process delivers:

Summary of Current CDM condition
Report of findings and issues
Recommendations for change and improvement
Education for facility staff

For detailed information regarding SunStone Consulting Charge Process Solutions, please contact Tim Mosco at 717-469-0386, or via email at timmosco@sunstoneconsulting.com.