Additional Payment Modules

Additional payments are often missed by the CDM reviewer because the charge is identified with a revenue code only and/or no associated CPT/HCPCS code. Often the narrative charge descriptor is a generic product name and the user is unfamiliar with the product's special classification status. Such charges, unless properly identified, will be bundled into the procedure APC payment, and additional reimbursement will not be forthcoming.

The module's logic isolates CDM charges containing narrative that appears to qualify for these special categories. The user may then use the associated information provided to:

Select an appropriate CPT/HCPCS code that qualifies for additional payment,

and

Determine and correctly identify the appropriate billing unit associated with the CPT/HCPCS code.

Analyze and disregard the charge as non-qualifying for the special category.

The operation of the Additional Payment Pharmacy module and the Additional Payment Supplies module is identical. The process that you follow is identical for both modules.

Use these modules after a full review of the charge items has been completed.

When the module is started, the Chargemaster Toolkit scans all the charge items on the Valid and Supplies tabs. It displays possible discrepancies that could result in problem charge items. You should evaluate each of these, and correct any problems.

To use the Additional Payment modules

Choose Modules > Additional Payment <module> from the main menu. The appropriate Additional Payment module dialog box appears. It displays all charge items on the Valid or Supplies tabs that have a potential problem.
Click on a charge item in the top part of the dialog box. Possible CPT codes and descriptions are displayed in the lower left part of the dialog box. [Picture]

If there is more than one suggested CPT Code/Description, select them in turn to display any potential problems. These display in the Comments area.
If appropriate, modify the charge item’s service description, CPT code, revenue code, (dollar) charge and volume in the usual manner from the tab, or use the various right-click options that are available.

From the list of problem charge items: Ignore charge item.

If you use the module again, the potential problems are re-displayed.

From the Comments area:

Use these units to use the recommended units.

Add a memo to add the comment as a memo.

You may only use these options if the relevant CPT Code has been applied to the charge.

From the Possible CPT Codes area:

Use CPT Code to replace the CPT code and modify the revenue code to match that of the suggested charge item.

Add new charge item.

Use CPT Code and AMA Short Description.

After you have dealt with the potential problem it is removed from the list.

To print charge items that have a potential problem

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