The hospital CDM (Charge description master), or the hospital charge master is the core of the revenue cycle. CDM or hospital charge master also provides the initial point to begin the process of billing patients and payers. Let me brief out what exactly is hospital charge master? It is a record of services which can be billed and billable things to the patient or its health insurance provider. The charge master captures the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the hospital, as well as any fees associated with services, such as equipment fees and room charges. Charge master today is not just an element of a hand operated system to produce bills & related claims instead it is a file found in billing or A/R system of hospitals. As there are numerous hospitals with computerized billing processes, however, the specific structure, design, and capacities of the charge master might differ.

One of the most essential components of healthcare revenue cycle is charge master. To be more precise, it is the chief data for producing the detailed report and claim document. Charge master should be equipped with specific data to produce the detailed report and claim document despite being provided a computer system execution. It has the data to produce a detailed report and claim document, enhance organizational tools, and support the charge master. Healthcare facilities can also employ charge master to produce analytical data regarding the services. In few scenarios, a provided line product might have no charge assigned as the facility utilizes it calculate supplies or services for analytical data. The charge master personnel choose to permit such usage.

The charge master comprises subsequent elements for every service such as item no. designated to the facility & special to one service or item specific detail of claim, CPT or HCPCS code, short details of CPT or HCPCS as item description, code of revenue, assigned department numeral, fee assigned for service or item specific detail of claim, substitute code for CPT/HCPCS code due to added codes are required by the same payer, for accounting usage the ledger number, and chargemaster prices for numerous services rendered by providers decided by the every hospital.

The charge master prices of the hospital are negotiated with private payers for reimbursement as majorly the charge master prices are not viewed by patients except when they don't have insurance and have pay in accordance with charge master. Henceforth, the prices on chargemaster were set higher than that of the provided care by the hospitals for two major reasons which are to survive the competition and haggle raised charges from private payers. Majorly every hospital is charging approx 15- 19 times more than the actual cost of the services rendered for CT scans and anesthesiology. And other services are also charged more than their actual cost and this trend is majorly observed in hospitals with over 50 beds in accordance with a recent Health Affairs study. Nevertheless, hospitals may need to reconsider the price for the services due to the rising demand for charge transparency.

Chargemaster can be designated to a person or groups to improve in accordance with the size of the healthcare or a hospital. For smaller healthcare facilities majorly in rural areas, this responsibility to set up and support chargemaster might be a part-time work. However, in mid-sized healthcare facilities, a proper chargemaster coordinator needs to designated. Nevertheless, in large healthcare facilities, a small group of people is required to support the chargemaster.

Organizing and managing a chargemaster is not plausible for one person or a small group. In numerous scenarios, it has been seen that team handling chargemaster mostly are from the staff of the administrative section closer connection to the chargemaster. Similarly, compliance personnel and health information management are involved in the chargemaster process of billing, reimbursement, and coding. The substantial element of hospital's account & receivables computer system is chargemaster and its status should also be monitored by information technology.

The duties of the chargemaster coordinators comprise designating revenue codes, collecting departmental reviews, teaching other staff on pricing and billing methods, examining code changes & rates, erasing or substituting codes, and recognizing rates under Medicare rates. They should have unrestricted interaction with clinicians to assure the billable services and prices in the chargemaster holds are correct. As clinicians are aware of the services are in demand and which are seldom required. To assure clinical documentation and coding practices are in agreement with chargemaster by chargemaster coordinator or chargemaster team should collaborate with coders and billers as ineffective coding could produce missing charges and leaked revenue.

The real control of charge master depends from organization to organization as in numerous hospitals several departments and service areas have accountability for the chargemaster’s entirely completed and correct. According to which the chargemaster coordinator is the guiding beacon and descriptive source for the facility. In various scenarios, the service area staff is unaware of the technical data concerning the chargemaster though they are aware of the activities, drugs, supplies, and other services provided in their area. Therefore, the chargemaster coordinator works in coordination with all the service areas to enhance a uniform and compliant chargemaster. This is an important as even one of them ineffective can result in huge errors as codes & documentation are decoded via charge capture to chargemaster rates. To bill the patient and generate a claim for payers the charge is then utilized. Keeping the hospital chargemaster on right track is the solution to revenue stability. An incomplete chargemaster can cause in claim denials, compliance breaches, more payment or less payment of fee more than actual, and charge less for services rendered. 

OAT has done a webinar on “Chargemaster Coordinators Duties and Functions” which review the Purpose and Function of the Chargemaster.