CHBME case studies
CHBME · Put your knowledge to work in context.
The Certified Healthcare Business Management Executive (CHBME) is an individual certification offered by the Healthcare Business Management Association (HBMA), a non-profit professional trade association that describes itself as a major voice in the U.S. revenue cycle management industry and as a recognized RCM authority by both the commercial insurance industry and the governmental agencies that regulate or otherwise affect the U.S. The CHBME case studies are 5 cases and about 4,031 words.
1The Batch Report That Proves Nothing
A 12-provider orthopedic group bills a regional commercial payer under a contract with a 90-day filing limit from date of service. A 8,420 claim, DOS March 3, went out electronically on March 10.
795 words, about 4 min2Twenty-Five Percent That Isn't in the Contract
A surgical group has a commercial contract paying 118% of Medicare for surgical codes, with a multiple-procedure reduction of 100% for the highest-valued procedure and 50% for each additional procedure in the same operative session. A claim contains three codes: 29827 (Medicare allowed 1,800), 29826 ( 700), and 29824 ( 500).
791 words, about 4 min3Observation, the Three-Day Rule, and the Missing Notice
A 74-year-old is admitted through the emergency department on January 12 with community-acquired pneumonia. The hospitalist writes an inpatient order the same day and documents an expected stay beyond two midnights.
825 words, about 4 min4Cleaning the Aging Before a Loan Application
A solo cardiology practice is preparing a bank loan application. Over the trailing twelve months: gross charges 5,900,000, contractual adjustments 1,850,000, payments 3,100,000, and gross accounts receivable 1,240,000.
766 words, about 4 min5The Offset With No Itemization
On September 3, a multi-specialty group receives a one-page letter from a commercial payer: a post-payment review of claims from January through December 2023 identified $64,300 in overpayments on 99214 billed with modifier 25, and the amount will be offset against the next remittance on September 20. The letter includes no claim list, no dates of service, and no rationale beyond the code pair.
854 words, about 4 min