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Strategies for when a health plan asks for your CDM

Patient Financial Services Weekly Advisor, January 28, 2005

Health plans are increasingly asking hospitals for copies of their description masters (CDM). It could be because they want to determine whether your facility increased fees by more than the consumer price index percentage set in your contract, or maybe they're making sure your facility isn't engaging in illegal price fixing with your competitors.

Whatever the reason, you might be targeted. And like most providers, you probably don't want to divulge your CDM to a plan.

Just because a plan wants your CDM it doesn't necessarily mean that it is entitled, says Jeff Sconyers, Esq., vice president and general counsel at Children's Hospital and Regional Medical Center in Seattle. To see whether you're required to hand over your CDM, try the following:

1. Review state laws. There's no federal law on this issue, but you need to check whether your state law requires you to divulge your CDM. State law varies widely. For instance, California recently passed a "Payers' Bill of Rights" that requires hospitals to make their CDMs public. It also bars hospitals from forcing plans to give up their right to see the hospitals' CDMs.

Other states require providers to give itemized bills or explanations of charges to patients, making the obligation less clear. If this is the case in your state, you have a better argument against handing your full CDM to a plan than providers in California. Some states don't address the issue at all.

2. Review your contract. Determine whether your contract requires you to give a copy of the CDM to the plan. Contracts often include this requirement, but you may not realize it's there until the plan asks for the CDM, says Sconyers.

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