Three steps to charge code approval success

Thursday, June 7, 2018

by Anna Santoro MBA, CCS, CCS-P, RCC

Oversight of the charge description master (CDM) is extremely important to ensure the accuracy and integrity of the CDM data. Diligent oversight starts with the approval process between the clinical departments and the team that oversees the CDM, and it ends with the CDM team’s internal approval process. The three steps in the approval process are: charge code request submission, review, and auditing.

Establish a designated person(s) on the clinical team who is authorized by the department head to submit charge code requests to the CDM. Selecting a designated charge code requester is a key function and is the first step in ensuring that charge code requests are accurate. By centralizing and formalizing the request process, you avoid confusion within clinical departments, streamline their process, and enhance communication between clinical departments and the CDM team. The charge code request should include a list of required data fields. This is usually a spreadsheet that outlines the data elements needed to upload the information into the CDM and the information necessary to complete a charge code. That submission process also creates an audit trail.

Once the CDM team receives the charge code request, it may opt for one of several different review processes. Some CDM teams might assign one person to both review the charge code request data elements and approve the request. Other CDM teams may have multiple staff members review the data elements. A CDM team could also have one person in charge of approving revenue codes, another person who reviews CPT®/HCPCS codes, and yet another person who sets the prices. Regardless of how your CDM team is setup, ensure the process is well documented and outlines the approval process and, if applicable, the handoff process between the CDM team members.

The last, and probably most important, step in the charge code request process is validating that the charge code is uploaded correctly into your CDM. Whether the CDM team uploads the information in an auto electronic function or as a manual process, you want to assure the uploaded data elements are entered into the CDM correctly. Use a checklist to verify the information in the CDM during audits. Never assign the same individual to approve the charge code request and complete the subsequent audit. Choose a different individual on the CDM team or a staff member from the same department who is not involved in the CDM review and approval process.

Note: Santoro is a revenue integrity system director at Hartford Healthcare in Newington, Connecticut. She has 20 years of experience with charge master, claim edits, denials, and coding. She is a NAHRI Advisory Board member.