This evaluation helps you assess where your facility is in the annual CDM Update process.

Department CDM Update Internal Evaluation

(Send to all Department Representatives involved in your annual CDM update process)

Points           Quality/Frequency (as applicable)

1                    Bad

2                    Poor

3                    Fair

4                    Good

5                    Excellent 0 Not applicable

Evaluation Questions

____       1. Orientation to /overview of the hospital’s annual CDM update process

____       2. Support from hospital leadership (ex. for allocation of time, resources needed, assistance needed, etc.)

_____     3. Explanation from Charge Management /Revenue Cycle leadership why you or your department was involved in the annual CDM update process

_____     4. Communication of assigned annual update tasks and responsibilities

_____     5. Communication of due dates for annual update activities assigned to your area

_____     6. Availability of time to perform requested annual update activities

_____     7. Access to necessary and complete resources and reference information for assigned annual CDM update tasks

_____     8. Guidance/assistance with data changes or charge capture impacted by regulatory or payment system changes

_____     9. Education and guidance on coding changes for your service area (new codes, code changes, deleted codes, HCPCS vs. CPT-4®, changes to charge usage/structure due to code changes, etc.)

_____    10. Education/guidance on payment or pricing indicators or edits (eg. OPPS Status Indicators, I/OCE edits, MPFS Payment Indicators, HCPCS Pricing Indicators, etc.), and how they impact CDM annual updates

____      11. Tools, forms, reports or other mechanisms used for performing annual CDM revisions (e.g. what to do and in what format)

_____    12. Instructions for submission of annual CDM changes (guidance on tools, forms, research requirements, fields to complete, due date, who to call for help, etc.)

_____   13. Instructions and information on impact to charge protocol, charge capture processes, and/or tools due to annual changes

_____   14. Availability of Hospital/Corporate standards, policies, and procedures to support decisions for CDM revisions & usage

_____   15. Clear communications on areas pending Medicare (CMS) clarification and why data changes may be delayed.

_____   16. Input on information systems problems or functionality updates to support the required charge data changes in the current environment (not in a future upgrade or HIS system)

_____    17. Input on pricing rules, parameters, guidelines and market comparisons or pricing standards for your area’s services/items

_____    18. Clear direction about charges that require ‘hard coding’ of CPT-4® codes in the Charge Master file vs those coded by HIM/Medical Record Coding

_____    19. Instructions and suggested methodology for post implementation quality control of annual CDM changes for assurance of correct data entry

_____    20. Overall quality, guidance and support from Charge Management / Revenue Cycle (e.g. your contact people who help with annual Charge Master revisions).

__________  Total Score

Annual CDM Update Evaluation Scoring

Points                Grade
100-95                    A        The Health System appears to be doing a very good job with the annual CDM update process.

94-85                      B         The Health System has developed an annual CDM update process and appears to follow an organized approach. However, there appears to be room for improvement.

84-75                      C          The Health System has initiated a program for annual CDM updates, but appears to need to expand its efforts and/or performance.

74-65                      D          The Health System has some key elements of an effective annual CDM updates program, but there appears to be significant need for improvement. There may be potential for compliance and/or revenue risks.

< =65                      F            Needs Immediate Improvement – Your hospital appears to be at high risk for lost reimbursement and/or compliance problems associated with what appears to be inadequate annual CDM update processes.

Comments

____________________________________________________________________________ ____________________________________________________________________________

Optional Contact Information: Name/E-mail /Phone

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Thank you for participating in this Evaluation. The Charge Management/ Revenue Cycle team will share plans for improvements or any concerns you’ve expressed. Please immediately reach out to our team for any charge-related compliance issues or urgent matters. Your input is important to us.

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