CBHPM is the acronym that stands for the classification of medical procedures in Brazil, and is a reference form for calculating medical expenses.
The table was launched in 2003 with the main objective of guaranteeing the remuneration and appreciation of health professionals in the private sector.
Therefore, it seeks to value the services provided by professionals and maintain a fair relationship with the supplementary medical system.
How important is it?
Today, in addition to the National Supplementary Health Agency – ANS, the regulatory body of the Ministry of Health in Brazil, CBHPM is widely recognized and incorporated by several health providers, even being used for the TUSS table coding.
Who developed it?
Taking into account the proposed objectives, the table was prepared by the Brazilian Medical Association (AMB), involved in the process of formulating the medical professional entity, Fundação Instituto de Pesquisas Econômicas (FIPE), and supported by other medical entities, such as the Council Federal Medicine.
Why it matters to healthcare auditors
In a hospital environment, the CBHPM is very important for billing accounts and releasing expenses and procedures carried out during hospitalization.
Therefore, hospital auditors and administrative departments must have in-depth knowledge of this to avoid possible administrative permission.
On the other hand, when auditing hospital accounts, health care provider auditors They also need to master the knowledge of tables to check the amounts and ensure that the payment is correct.
How to calculate the consultation value with the CBHPM Table?
CBHPM determines the value range for the medical procedure according to the size of the medical procedure.
The listing does not indicate the monetary value, but indicates the program identification and reference for standardized price calculation.
The hierarchy is based on the division of medical procedures into 14 sizes, divided into three subdivisions: groups A, B and C.
This division follows the following parameters:
- Technical complexity;
- Runtime;
- Attention;
- The degree of professional training required.
Based on these parameters, the port and its subfolders are created.
Each time the CBHPM table is readjusted, a new operating cost unit (OCU) is defined.
UCO includes depreciation on equipment, maintenance, furniture, real estate, rent, salaries and other service-related expenses.
Therefore, the formula for CBHPM to calculate medical expenses is as follows:
(Postage value * Subshipment value) + (Operating Cost * UCO) = Price
Subport and OAU values have been revised to compensate for the loss caused by inflation.
The basis for calculating the adjustment is the National Consumer Price Index (INPC), measured by IBGE.
According to the statement released by AMB on October 18, 2019, the current value of the UCO is 21.07 reais.
This reference is valid until September 2020, when a new adjustment notice must be issued.
Furthermore, the latest version of the CBHPM Table can be purchased on the official website of the Brazilian Medical Association.
Practical example
So, let's look at an example of applying the CBHPM Table to calculate a procedure.
We will do the calculation for the 10.11 Epoxide Carbamazepine test, serum:
- Location at CBHPM: Biochemistry, code 4.03.22.35-1
- Port: 0.04 of 1A
- Subport value 1A = R$ 23.46
- Operating cost of this test: 6,942
- UCO value: R$ 21.07
- Port calculation: 0.04 x (1A subport value) = 0.04 x R$ 17.38 = R$ 0.9384
- Operating cost calculation: (Operating cost) x UCO = 6.942 x R$ 21.07 = R$ 146.26794
Final test price: R$ 0.9384 + R$ 146.26794 = R$ 147.20 (with rounding)
Source: Amplimed
In short: the CBHMP table is essential for an effective audit, thus avoiding possible bottlenecks that may occur throughout this procedure!
For healthcare providers, using the best systems for managing healthcare costs is the best way to accurately control expenses and maximize profits!
In this article, you learned what the CBHPM table is and the main benefits of using it in your audit or management of health plan operators.
Standardized procedures and calculations of negotiated values are important principles of your financial management.
SAUDI is committed to improving the capabilities of its management software to facilitate the daily lives of managers and auditors.
This way, our customers can access the TISS form and the module dedicated to this subject.
O TISS billing module was developed to provide transparency to medical expenses and improve financial management, both for operators and health service providers.
Therefore, the degree of assertiveness, transparency and speed in transmitting these values can affect the financial management of a given clinic and bring rework for auditors and health plan managers.
This is the practicality that SAUDI technology can bring to your day-to-day auditing!
Do you want to know more about how you can be successful and lead a project to further improve your operator's medical bill audit? Click here and ask our experts for more information.
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