Your CFO is not convinced that a clinical documentation improvement program will be worth the cost of development and implementation. What could you do to convince her otherwise?

Chapter 5

Critical Thinking Questions

Your CFO is not convinced that a clinical documentation improvement program will be worth the cost of development and implementation. What could you do to convince her otherwise?

It is January 10 and your coding manager has just brought you a list of accounts that cannot be finalized because the CPT codes attached to the charges are not valid. Your HIM systems were updated for the January 1 CPT code changes. What could be the problem and how will you fix it?

It is suggested in chapter 4 that back-end reporting should be reviewed in order to monitor compliance with specific billing rules. One such report is to monitor the CMS 3-day payment window. What data would you want to have on a report to monitor this rule and how often would you run it?
For the following questions, use the Costing Example Excel file provided in the online materials.

Use mappings to figure out cost-to-charge ratios for departments not yet calculated.
Apply relevant information to the trial balance to populate the cost centers, sub-account information, salary/other types, and cost center.
In the charge section, apply mappings for cost center departments to the CDM summary.
Aggregate costs and charges in the cost-to-charge ratio tab
An audit has uncovered mammography charges in an off-site clinic, but the costs for the mammography services are already allocated to the RAD-MAM department. The total charges for mammography in the clinic are $300,000. What is the new cost-to-charge ratio for mammography?

6. Due to competitive forces and favorable managed care contracting, management decides to restrike radiology charges such that the cost-to-charge ratio for each radiology department will be no less than 0.5000. What is the target for total charges for each category? If the change to charges is uniform, what is the factor to apply to each cost center’s charges (old price ? conversion factor = new price)?

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