Required Reading: Oachs, 5th Ed, Chapter 8, pages 250-254.

Cure All Hospital has received a number of payer denials for services billed with incorrect CPT codes and revenue codes. After investigating, Jane discovered that several departments were submitting their charges using electronic source systems or paper charge tickets that had not been updated to match the billing system's charge master. Discuss what Jane should do to correct this problem and measures that should be put in place to ensure that the CDM is correct and that electronic source systems and paper charge tickets are updated. Consider the following in your analysis:

1. Give examples of charge source systems or departments submitting charges using electronic source systems or paper charge tickets (paper, electronic?)

2. What should Jane do with electronic source systems or paper charge tickets that had not been updated?

3. Should audit be performed? Should there be accountability assignment? (Why or why not?)

4. Should CDM be reviewed regularly? If so, how often and why?

5. Identify what line items should be regularly reviewed in the CDM.

6. Identify who is responsible in each department who should know the items in their cost center's charge master (CDM).

7. Identify who will be informed by the responsible departments about changes to services being performed, or supplies being used in their area.

8. Include discussion of all resources used to support CDM maintenance. Is it interdisciplinary?

This case study was developed by Oachs, 5th Ed, Chapter 8 as part of the instructor manual