Say Yes to Chargemaster Success

By Mark Boudreaux, Director, Product Management | Posted: 11/05/2019


Your health care organization’s chargemaster (CDM) is the heartbeat of the revenue cycle, the source of truth that reflects all costs and feeds all billings. It’s also key to successful Price Transparency efforts. Accuracy is essential to promote correct patient bills, optimum revenue and compliance with Medicare rules. But managing the chargemaster engine requires maintenance. Between quarterly regulatory updates and frequent service modifications, chargemaster content can change daily.

How do you maintain a healthy CDM for your health care organization and for Price Transparency?

Verify chargemaster integrity. Institute a process to confirm that everything you buy and use is entered into the CDM and the pricing is up-to-date. Ensure that codes are accurate and meet government regulations. If there is no charge code for supplies and services, you cannot charge for them – that translates to lost dollars that negatively impact your revenue cycle. This happens easily enough when there are so many regulatory changes to contend with; no wonder items are missed and revenue is impacted.

It is important to know what is not chargeable. Non-chargeable items that slip into patient billing will result in a compliance violation.

Who is responsible for ensuring the completeness and compliance of the CDM?

Usually, it is up to the internal staff to interpret new regulations and input new items. The process is labor intensive and requires a lot of time and energy to conduct online searches and successfully navigate the Centers for Medicare and Medicaid Services (CMS) website. A more effective approach is to utilize technology and consulting services to help automate and improve CDM capture processes.

How to choose a chargemaster service?

When selecting a service, ask if their capabilities review 100 percent of CDM items, including patient observation and other soft code charges. This is crucial because the number of lines in the Healthcare Common Procedure Coding System (HCPCS), which is authored by Medicare and the Blue Cross Shield Association, represents not even half of the items found in a typical CDM. The others can represent a variety of line items that do not have a Current Procedural Terminology (CPT) HCPCS code and, if the items are not set up properly, they could go unbilled.

Ensure the service provider is vendor agnostic and can work with all the leading electronic health care record (EHR) systems plus integrate with patient accounting systems.

How much CDM revenue loss are we talking?

It varies among health care organizations, but lost revenue can run into the millions. In one instance, a health care organization approached nThrive to resolve missing CDM items and ineffective charge capture. Our team helped develop a formal process to identify key roles and duties of the clinical and coding staff, which, once corrected, began returning an average of $500,000 - $600,000 in net revenue per quarter or approximately $2 million annually. nThrive technology is vendor agnostic, which makes it possible to work in one tool to eliminate dual entries. We work with organizations to improve processes and train staff on how to use our technology effectively.