by Laurie M. Johnson, MS, RHIA, FAHIMA
The chargemaster or charge description master (CDM) is an electronic tool or file that maintains all services, supplies, and medications to be charged during a patient visit. When this tool is combined with the facility’s Revenue and Usage Report, an analyst can determine what services are utilized.
There are some basic questions that should be asked related to your chargemaster:
1. Has the file/tool been updated to incorporate the latest code (CPT or HCPCS) changes?
Yearly or even quarterly reviews of CPT and HCPCS code changes as well as periodic wholesale audits of the entire chargemaster will ensure that the codes are accurate as well as services and pricing.
2. Have planned services been built in the chargemaster?
New services should be built and tested in the chargemaster prior to the need to charge for them. Regular communication with clinical staff to identify new areas of service, often tied to significant new physicians, should be done to avoid missed charges.
3. Are we performing any services that are not reflected in the chargemaster?
The CDM can be the source of lost money when an item is overlooked in the chargemaster, but the service is still provided to the patient.
For example, I worked with a facility that decided charging for infusions and injections was onerous due to the complexity of the service and the difficulty of obtaining accurate clinical documentation. They decided not to charge for infusions and injections. After the frequency of this service was reviewed, it was determined that millions of reimbursement dollars had been overlooked!
The solution included training clinicians on how to document infusions and injections, training coders how to code them, and reviewing the chargemaster to ensure the coding would flow through accurately to the bills. I know many coders that would learn how to charge infusions and injections if they could be paid a portion of the lost millions!
Errors in the chargemaster can be the cause of billing issues which are delaying claims processing and in turn delaying reimbursement. Because no one is listening to the billers regarding a chargemaster file error, the billers are constantly spending extra time having to update a claim before it goes out the door. There is lost money in billing efficiency.
I am calling for the coders to become more familiar with the chargemaster file and how it is utilized in their facility. There is gold in the chargemaster, and the coders know how to find it!
Watch for my next blog where I will provide more information on turning the mid-revenue cycle into more gold.
Proper coding of Injections and Infusions leads to accurate reimbursement and less frequent denials. However, this type of coding may not be easily understood by just reading through the guidelines. Demystify this difficult topic with the course Injection and Infusion Coding for Facilities.
Laurie M. Johnson, MS, RHIA, FAHIMA Laurie M. Johnson is a senior consultant at Revenue Cycle Solutions, LLC, a revenue cycle consulting firm specializing in revenue cycle assessments and work plan implementation; interim management with focus on process improvement; and revenue cycle education for hospitals and physician practices. Laurie is a past president of PHIMA and author of clinical coding articles for Journal of AHIMA and ICD-10 Monitor.