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T H E C . U . R . E . ™
CDM AND UNCAPTURED REVENUE EVALUATION
September 17, 2007
St. Example’s Medical Center—Emergency Department
Executive Summary
• Engagement Overview
• Process Overview
• Major Issues
Charge Description Master
(CDM)
CDM File Changes
ED Charge Ticket
Charge Capture and Charge
Entry
Coding and HIM
Billing
Other Issues and Summary
Appendices & Reports
Contact Us
http://www.sinaikohc.com
CURE@sinaikohc.com
EXECUTIVE SUMMARY
Engagement Overview
Sinaiko Healthcare Consulting, Inc. (“Sinaiko”), was engaged by St. Example’s Medical Center to
perform an evaluation of the charge capture processes for the Emergency Department (ED).
Sinaiko’s C.U.R.E.™ methodology is designed to assess the major elements of the charge genera-
tion and capture processes.
Process Overview
The C.U.R.E™ method touches all segments of the ED Revenue Cycle to measure the effectiveness
of charge capture. Over the past few weeks our activities at St. Example’s included:
• Evaluation of the ED Charge Description Master (CDM) against industry standard
• Evaluation of the ED Charge Ticket
• Chart-to-Bill Audit of 50 ED Visits to Compare What was Documented Versus Billed
• Evaluation of the ED Coding Effectiveness
• Onsite Observation of the Charge Capture/Entry Processes and Their Effectiveness
Major Issues
The subsequent pages of this report illustrate the details of the charge capture deficiencies for the
facility. The high-level summary of the issues are listed below:
• Charge Description Master: Missing injection and infusion codes; “Courtesy” no charge
• Charge Ticket: Level of Care confusion, Office visit charges on ED charge ticket
• Charge Capture/Entry Processes: Lack of education and training; lack of auditing
• Coding: Routinely missing implants and supplies and their associated procedure codes
• Billing: Incorrect usage of “1 unit” for injections when multiple injections were provided
Financial Implications
ED Visi