Keeping Your Chargemaster Updated is More Important Than Ever

With the recent legislation around price transparency for healthcare providers and insurers, the importance of maintaining your charge description master has become even more crucial.

The charge description master (sometimes called “Chargemaster” or “CDM”) is, in essence, the price list for the services provided by the healthcare provider. It has always been important to keep the CDM up to date because it is the key connection between the services provided and what will show up on the bill to the insurance company or patient.

In a small physician practice, the CDM may be just a list of the common CPT-4® and HCPCS codes used in the practice, with a charge amount that will be billed for the service, device, or supply.

Maintenance in a small practice typically includes reviewing quarterly updates in CPT-4® and HCPCS from payers and reviewing charges in comparison to payer fee screens. However, with staff having to wear many hats, CDM review can often fall through the cracks.

On the other hand, a hospital, depending on size, may have one person whose full-time job is to process CDM changes. Even with that person spending all their time with the CDM, a comprehensive review of chargemaster often doesn’t happen regularly.

A hospital CDM can easily contain over 25,000 lines across dozens of revenue-producing departments. Some charges are hard-coded with CPT®/HCPCS codes, while some are “soft-coded” in the coding department. Some charges are directly input by departments, while others are triggered by subsidiary systems (e.g., pharmacy system, laboratory system, etc.).

A comprehensive review of every hospital CDM should be completed each year to address not only code changes, but also underused charges, inconsistencies of charges within and between departments, incorrect UB-04 revenue codes, and pricing compared to payer contracts.

In the new age of pricing transparency, every hospital is required to publish their charges. Before the hospital publishes their updated prices each year, it is ideal to review pricing and how it will be perceived by the public. For example, are you charging $50 for an aspirin? How do your prices compare to others in the market, especially for “shoppable” services like lab tests and imaging?

The importance of maintaining of your CDM has become even more important. Be sure your facility has reviewed its CDM goals and has developed and implemented a plan to ensure both revenue as well as compliance with regulatory requirements.

The Rybar Group has extensive experience in chargemaster development and review. We would be glad to schedule a time to discuss your chargemaster goals and develop a plan that improves both revenue and compliance while reducing the workload of billers and others involved in the revenue cycle.