Hospital Chargemaster Management: Understanding Best Practices

In recent years, consumers and politicians have been calling for businesses in the healthcare industry – especially hospitals – to be more transparent about billing practices. This has put hospital chargemasters on center stage, highlighting the cost of medical procedures, hospital services, medications, equipment fees and diagnostic tests, among other charges. Revenue cycle leaders should regularly evaluate how they manage their chargemaster to ensure that best practices are being met.

Determining Charges

Identify which services are chargeable and which are not. Additionally, it is important to see how much the other local hospitals are charging for the identical service. Doing so allows you to assign reasonable yet competitive prices to these services. However, it’s important to understand that overhead may be different for certain clinics, such as off-site clinics.

Updating Codes

Using a chargemaster management system, make sure that billing codes are correct. Codes continually change, especially those assigned to reimbursement. The American Medical Association regularly revises the Current Procedural Terminology code set, which is used to bill office and outpatient procedures. Failing to match these codes can lead to payment issues.

Reviewing Code Descriptions

Part of the chargemaster audit process includes making sure that code descriptions are accurate and clear. Clinicians will not be able to efficiently use the code sets if the descriptions are not easy to understand.

Getting Clinician Assistance

Encourage clinicians to interact with the chargemaster and provide feedback. Having discussions about codes that are missing or that need to be revised can help revenue cycle leaders get in front of issues. Also, when clinicians are informed, they are less likely to miss a code or incorrectly bill clinical services rendered.

Identifying charges, reviewing codes and keeping clinicians informed are all part of the charging best practices used by hospitals. By following these steps, you can better ensure an accurate and effective chargemaster.