Hospital Chargemaster Basics: What It Is, How It Works, and Why It’s So Important

什么是医院管理者?

The chargemaster, or charge description master (CDM), is a database that contains a comprehensive listing of items that could produce a charge. The chargemaster will have a record for everything in the health system that relates to patient care. Broadly speaking, the chargemaster includes charge data about:

• Procedures and services provided by hospital personnel and supported by hospital facilities
• Supplies, devices, products
• Drugs

Every clinical department that provides a service or product to a patient will have representation in the CDM. The data is used to charge accurately for those services or products in accord with regulations and payor requirements. The opposite is also true, any service that’s not represented in the CDM can’t be charged for, and won’t result in a charge.

Hopefully it’s already becoming clear why the chargemaster is so important to the hospital’s financial health. We’ll pick that train of thought up in more detail later, but first, let’s go over some of the data that the chargemaster manages. This will help us better understand how it works.

Overview of Hospital Chargemaster Data

清洁发展机制中的数据描述了所提供服务的性质和价格。请参考下图中的一些示例，我们将逐列地讨论每个数据字段。

CDM Data Examples

Department Number

The department number reflects the department from which the service, drug, or product was supplied to the patient. Department numbers are hospital-specific and not nationally standardized.

Charge Code

这是一种独特的代码，用于标识特定设备、服务或药物的特定费用。比如x光胸片，像枢复宁这样的药物，或者像起搏器这样的设备。没有两个收费密码是相同的。

Charge Description

这些是用来标识要收费的商品或服务的文本描述，通常被压缩为26到36个字符。字符限制是由使用的各种患者会计系统(PAS)施加的。收费说明是医院特有的。

Revenue Codes

Revenue codes are universal and not hospital-specific. All hospitals across the country use the same revenue codes. They’re established by the NUBC (National Uniform Billing Committee). Some payers prefer specific revenue codes for some services.

CPT or HCPCS

CPT are created and maintained by the American Medical Association (AMA) and are universal across all hospitals. HCPCS codes are created and maintained by the Centers for Medicare & Medicaid Services (CMS). These codes represent the particular service or item that you are charging for, but may also have specific payor requirements.

Modifiers

修饰符是特定于特定代码的，最流行的是用于横向(左/右)。其他人可能会描述数字或提供者:如全科医生、物理治疗师、语言治疗师等。一些修改会影响报销，而另一些则不会。

Price

There is often confusion between price and cost. The “price” is the price the hospital charges the patient, while the “cost” is the expense to the hospital to provide the service (e.g. overhead, salaries, equipment, supply and drug expenses). Price = patient cost. Cost = hospital cost.

There are additional data files that may or may not be housed within your CDM system. Things like cost, fee schedules, and manufacturers. We believe a modernCDM solutionshould be able to house all these things in a single tool.

Maintaining The Hospital Chargemaster

清洁发展机制是动态的，因为程序、包装、药品、法规和守则都在不断变化。但是它必须作为该信息的“主”权威来维护。这些信息可能在几天，甚至几个小时内就会过时，而且可能在几个月或几年里发生巨大变化。

When does the CDM change? The most common reasons are:

• New billable services and items
• Items or services no longer billable
• Annual and periodic code changes
• CMS regulatory changes
• Other regulatory guidance
• Payer contract changes
• New departments created
• Changes in cost to provide services, drug or supplies

In some ways, it’s better to think of the CDM more as a workplace than as a data repository. Aneffective workflow mechanismin your CDM solution is crucial for agile maintenance of your chargemaster.

In addition to daily maintenance, most organizations employ a combination of audits and formal reviews in order to ensure: 1) That CDM data is kept up to date and accurate; 2) That older codes are cleaned out of the system; 3) That charges exist for all billable services, drugs and supplies; 4) That interfaces and ancillary systems are functioning properly; and 5) That proper procedures are being followed throughout the revenue cycle ecosystem. A trusted CDM typically requires a combination of:

• Quarterly Reviews
• Annual Reviews
• Ad Hoc / Charge Capture Audits

These reviews can focus on various aspects of the data, or the overall function and efficacy of the various teams charging and bill for services. Here are a couple of additional resources on how to runyear-end chargemaster changesandcharge capture audits.

Maintaining Ancillary CDM Files

Pharmacy, professional,supplies, soft codes… there are plenty of other data points that need to be maintained similar to your chargemaster. If you’re using a legacy CDM solution, you may need to login to different tools or download separate spreadsheets to manage. If you’re usingVitalCDM, all of these files and departments can be managed within the same solution. Pharmacy is one of the most common examples of an ancillary system, and will include data points like the cost of the drug, the NDC code, the route of administration, strength, and billing conversion factor.

Deactivating Charges and Cleaning House

CDM应该是当前的一个快照。重要的是要有工具和流程，使其容易停用不再活跃的电荷，这样它们就不会意外地在患者的账户上充电。对于设施来说，永远不停用任何数据是很常见的，而这几乎总是导致混乱和拒绝索赔。学会使用去激活并建立一个定期的节奏(每月、每季度或每年)来检查很少或从不使用的代码和程序。你会很高兴你做了。

医院充电器是如何工作的?

The CDM is at the center of the patient financial system, which is why it’s often called the foundation of the mid-revenue cycle. It links to many feeder systems like your clinical system , order-entry, electronic health records, and your materials management system.

用最简单的话说，充电站是由生成收费或使用收费数据准备分项账单和索赔的系统访问和分发收费信息的地方。

用最简单的话说，充电站是由生成收费或使用收费数据准备分项账单和索赔的系统访问和分发收费信息的地方。

Common Charge Generation Workflows

Let’s take a look at a few typical procedural examples to better understand common CDM workflows. In every case, the chargemaster is being consulted, and data is drawn from it, to match the charge to the specified procedure, item, or drug.

Example 1

Radiology Order

We’ll begin with a radiology example. Typically, a chest x-ray is ordered in the order entry system and then sent over to radiology to perform the test. Once the “complete” designation is entered, the radiology system will trigger a charge for the chest x-ray to be added to the patient’s account. The charging mechanism here is “charge on completion”, meaning the charge is generated once the procedure is completed. In a simple process flow, it looks like this:

order entry > order acknowledged by radiology > X-ray performed > marked as completed > charge generated

Once the charge is generated, it goes through the patient accounting system, into the billing system, and finally ends up on the claim.

Example 2

Lab Order

This time let’s look at a common process flow for a lab-test, like a simple CBC:

order entry > order acknowledged > lab test performed > lab test resulted > charge generated

Note that the laboratory is usually a “charge on result” mechanism, meaning the charge is produced through the CDM once the result is noted. From there, it again goes to the patient accounting system, over to billing, and then the claim.

Example 3

Charge Via Documentation

Another increasingly common path for generating charges is through documentation. EHR systems have grown increasingly sophisticated over the years, so many hospitals are capturing charging via documentation by linking documentation of care given directly to the charging mechanism. This approach has taken hold specifically for calculating the evaluation and management (E/M) service level codes. The EHR system analyzes the documentation and assigns points to arrive at the suggested final E/M level.

Why Is The Hospital Chargemaster So Important?

记住，所有患者的收费都是由收费器产生的，并直接与收入挂钩。

The UB-04 is the standard form used to bill all insurance payors. Charges from the CDM populate the entirety of the middle of that form.

Examples of what will appear on the UB-04:

• Revenue codes
• Descriptions
• CPT/ HCPCS codes
• Modifiers
• Dates of service
• Units of service
• Covered charges
• Non-covered charges

Other Key Uses For Chargemaster Data

Cost Reporting

Medicare-certified providers are required to submit an annual cost report to CMS. This report contains information such as facility-characteristics, utilization data, cost and charges by cost center, and cost and charges by department (tracked in total, and separately for Medicare). These reports also include Medicare settlement and financial statement data.

Budgeting and Resource Allocation

拥有最新、干净的充电器的医院能够更信任用于战略财务规划的数据。Revenue generated by various hospital departments and procedures can be tracked through the revenue and usage figures associated with the charges in the CDM.

Inventory Tracking

对于那些没有独立供应管理系统的医院，清洁发展机制可以用来跟踪供应利用情况。即使他们有另一个系统，验证反对清洁发展机制也是值得的。

The Big Picture In Review

对这些基本知识的良好掌握有助于医院人员理解指挥员发挥的关键作用。The keys to success with the chargemaster can be summed up rather easily:

Make sure it’s complete.一个充电器不能消耗并代表你的设施的所有充电数据是低效的。当chargemaster不符合其名称中的“主”部分时，错误和不匹配数据的可能性会大大增加。

Make sure it’s maintained.chargemaster是一个移动的目标，是编码和临床数据中当前时刻的快照。让它保持最新需要专门的工作和专业知识，但它也需要一个设计为不断更新的系统。一个好的充电器不仅仅是一个数据仓库，也是一个人们不断工作和协作的地方。

Make sure it’s connected.Appreciate the central position the chargemaster occupies. Get as much of the data as you can flowing in and out of the chargemaster automatically so manual uploads and downloads aren’t necessary.

当所有这些都完成后，你的充电员会帮助你确保你的充电是干净、准确和正确的。仅靠充电器维护无法做到这一点，但这是一个良好的开端。除了定期审计和专注于收入诚信的努力外，一个廉洁的管理者是健康财务运作的核心。