Qualification Standards for Charge Review Personnel

Objective

To ensure that personnel hired to review diagnostic and procedural coding and other information to be included in claims for payment for health care items and services (“charge review personnel”) are adequately educated and trained.

Policy

All charge review personnel must have a basic understanding of the following:

• Medical Terminology
• Documentation Standards
• Current Procedural Terminology (CPT)
• International Classification of Disease (ICD)–ICD-10
• Use of HCPCS/CPT Modifiers
• Regulatory Compliance

All charge review personnel must demonstrate competence in these areas to the satisfaction of the Departmental Compliance Leaders in conjunction with the OFBC.

All charge review personnel must be provided with regular training and education opportunities both internal and external.

• All charge review personnel should attend a compliance training session as a new hire employee and every year thereafter.
• All charge review personnel must obtain professional certification as a CPC or CCS-P within two years of hire, and must maintain that certification throughout the course of their employment as charge review personnel at CUIMC.

Office for Billing Compliance
Policy#: OFBC 10021
Original Date of Issue: 1996
Revised: 3/22/2023
Reviewed: 3/1/2024