My specialty as a health care finance consultant is charge capture. To that extent, to do things right one should always start with the charge master. I call it the respiratory system of every hospital and medical entity, which includes doctors, because without having this set up properly it’s a crap shoot in trying to capture, code and price procedures properly.

Deilbert Consultant
Michael Sauers via Compfight

I gave a keynote presentation in 2007 on what a CDM (charge description master) consultant does in Virginia. I was told the participants would be hospital CFOs so that’s who I geared the presentation to. Instead, it turned out that the majority of people who came were CDM people; ugh. I still gave the presentation since I’d put it together, but since it wasn’t for them they didn’t get out of it what they needed to.

Luckily, for the most part they liked me and liked what I had to say because it bolstered them up in helping them see how important the job they did was for their hospitals. Still, not every hospital has a charge master person on hand as an employee. So, adding to the knowledge I doled out in this post for CFOs, I’m going to add more knowledge in this post and the next one. Great stuff for a weekend, since all the CFOs should be home and ready to read this. 🙂

Difference Between Consulting and Directing

Both segments will begin with the above line. That’s because I want to talk about why bringing in a CDM consultant is a wise choice and what we have to offer as opposed to having a full time employee, although the way I see things that would be a great thing as well.

1. Biggest bang for buck; then work backwards

A well qualified CDM consultant that’s hired for more than a CDM review (which is mainly reviewed offsite, then has time set to interview directors, writes up a report, talks about the report and normally moves on with life) should be able to come in and within a couple of days help to make some big changes by addressing big issues if they exist.

2. Establish peer relationships quicker; avoid adversarial relationships

By not being an employee yet tasked with a specific job, CDM consultants can come in, talk to anyone, not take sides, not deal with politics, and get things done. Someone with good people skills can get directors and others to work with them because hospital personnel are usually more inclined to want their hospital to run well, including the monetary side of things.

3. Need to keep up on many more things since day to day issues are different

A CDM consultant works independently. Most of the time they don’t have to worry about having employees report to them and they only attend meetings that directly impact revenue or receivables. That frees up their time to do what they’re brought in for, that being increasing revenue and cash while decreasing denials.

4. They’ll know many general details for all departments

There are usually two different kinds of CDM consultants; those with a medical background (nursing normally) and those with a financial background. Each comes with strengths that the other doesn’t, yet both will know enough to help make big time positive changes.

An example of something like this is thinking about catheters. Someone with a medical background will probably understand all types of catheters, how they’re used and be able to quickly identify the proper code to use for each one, if a code exists for them. Someone with a financial background may not be able to identify them on site or by the wording in a manual, but based on what they’re told by the department they’ll not only help departments realize which ones can legitimately be billed but help code and price them properly.

5. Must understand best practices as well as bad practices

Good CDM consultants will have at least a good passing knowledge of compliance issues. This becomes crucial when they have to tell either a department or a CFO that something they want to do is against compliance rules. That’s something an employee might be hesitant to tell you, let alone ignore a directive to do it, but a consultant’s reputation is on the line. Their goal should be to work with hospitals to keep them out of trouble with regulatory agencies and insurance companies while helping them get their charging processes in good order.

That’s part one; part two comes tomorrow.
 

Digiprove sealCopyright protected by Digiprove © 2015 Mitch  Mitchell