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Compliance Tab

Once the software has analyzed the CDM file for coding and billing issues, and all such issues have been addressed, the software then analyzes each line charge for potential risk issues.

If the software identifies a CPT®/HCPCS code or "word" within the narrative description of a Service Charge that may trigger a potential compliance or risk issue, the charge is placed under the Compliance tab for further review.

Entries under this tab may contain:

An unlisted CPT®/HCPCS Code
Codes with known compliance issues such as multi-channel lab tests
Codes that are currently under intensified review by the FI's.
Services that are currently under close scrutiny by the OIG
Non-covered services or Non-reportable services that are kicked out by the OCE
Common narrative that act as flags for auditors such as "portable", "routine", "gloves"
Services that require specific documentation standards for coverage

Over-billing for services, unbundling of service charges, screening and/or routine or preventive care are all considered compliance issues and should be noted before a charge can be accepted as a valid charge.

Viewing Compliance issue details

You can view more details about the flagged compliance issue by clicking on the Compliance Issues tab in the Active Info window. This tab shows a brief summary of each compliance issue associated with the current charge, along with links to associated regulations on the Internet.

Sorting charge items by compliance issue

You can sort all the items on the Compliance tab by compliance issue. This is useful as it lets you easily select and deal with several related charge items at once. To do so, click the Sort link on the Compliance Issues tab on the Active Info window. The application sorts the charge items on the Compliance tab so that items with the same compliance issue are grouped together. Alternate groups are differentiated using bands of color. The number of unique issues are displayed next to the sort link.

To attach compliance issues as a memo
Before sending a charge from the Compliance tab to the Valid Tab, you should record details of the possible compliance issue identified by attaching a Memo as follows:
1. Select the relevant charge item(s).
2. In the Active Info window, click on the Paste To Memo 'link. Doing so will copy the compliance text into the memo window. You can now edit or add to the pasted text before accepting the memo entry by selecting OK.
After pasting the compliance information into the memo window, you can modify, deactivate or include the charge item as appropriate. Craneware recommends that you consult a trained professional before including or modifying entries under the Compliance Tab.

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