CDM & Charge Process

OVERVIEW

Today more than ever, hospitals operate in a complicated financial and regulatory environment that demands complete and accurate billing to ensure appropriate reimbursement for the services provided.

Coupling the regulatory environment with changes in the healthcare delivery systems, your primary charging tool, the Charge Description Master (CDM) requires constant surveillance as the smallest oversight can expose a hospital to significant compliance and/or revenue risks. Let our dynamic, and highly customizable, CDM and charge process solutions help you mitigate those risks.

KEY BENEFITS

Our nationally recognized seasoned experts devote their time to ensuring the integrity of your CDM, to include the complex interplay of electronic interfaces to surpass payer scrutiny and denials, while ensuring you are receiving all applicable reimbursement for the services provided.  What differentiates our solution from the rest?  Aside from the talented group of reimbursement, coding and clinical experts, we provide the following:

  • On-site meetings with each department
  • Electronic review in addition to desk audit of each line on your CDM
  • Evaluation of order-entry sub-systems and their impact on the CDM
  • Comparison of HCPCS/CPT codes to payer guidelines
  • Evaluation of revenue codes for increased accuracy and applicability to cost reporting requirements
  • Identification of duplicate, unused and invalid HCPCS/CPT codes
  • Review of hard-coded modifiers
  • Pricing assessments relative to payment rates and similar CDM items
  • Identification of appropriate bundling or unbundling of services
  • Analysis of claims and associated medical records to ensure appropriate charge capture of all services rendered, and that your CDM is working

WHY IS THIS THE BEST SOLUTION?

Our consultants do the heavy lifting to reduce the burden on your staff, emphasizing teamwork throughout the process to ensure that all findings are discussed, understood and implemented.  It’s our way of ensuring we fulfill all the deliverables we both believe are important. 

WHAT OUR CLIENTS SAY

“For the past several years we've depended on SunStone for all of our reimbursement and chargemaster consulting. Their consultants are excellent and have consistently delivered terrific service at reasonable rates. We regard them as valuable members of our team.”

Kevin Brennan, CPA
Executive Vice President, Finance/Chief Financial Officer
Geisinger Health System

“We have utilized SunStone’s expertise for a number of years and can always depend on their availability when needed. They are subject matter experts in a variety of areas and always provide sound research and education to both our administrative and clinical staffs.”

Cassandra L. Mitchell, CPC
Associate Vice President, Reimbursement
UConn Health Center / John Dempsey Hospital

PART OF AN EVEN LARGER SOLUTION

As a full-service compliance, reimbursement and revenue cycle firm we are constantly developing new ways to assist our clients in becoming more compliant and generate more revenue.  Our team of experts look beyond the task at hand so we can bring other opportunities to your attention. 

LEADERSHIP

Timothy M. Mosco, M.S.
Vonda K. Moon, M.S.