Charge Description Master Maintenance if not up-to-date the facility/hospital will experience a loss of revenue due to claim(s) denials and missed charge-capture opportunities. It's challenging to keep the chargemaster accurate because the rules are continually changing: The Centers for Medicare & Medicaid Services (CMS) will make quarterly changes to the rule sets that includes revised or new policy, and if not reviewed through-out the year your facility will see a drop in revenue.
Another big component of risk is whether your chargemaster is complete. A chargemaster review is time-intensive and the various departments don't always understand the importance of the accuracy that has a negative or positive impact to each individual who assigns codes/charges. This includes inpatient or outpatient services. A complete and accurate chargemaster not only includes the facility charges, but what about any physician pro-fee charges? This is called a “fee-schedule” that could be ER doctors, Radiologists, Anesthesia (CRNA or Anesthesiologists) where the hospital is billing both components, but if not accurately priced or set-up appropriately will have a negative impact on revenue.
Smaller Critical Access hospitals (CAH’s) or Rural Health Clinics (RHC’s) etc etc., there isn't a dedicated staff person dedicated to maintaining the chargemaster database. Typically, CAH’s or even mid-level size community hospitals will outsource this function, so that the CDM/Fee-Schedule is complete with no worries. ECS can help you to make sure there is a process for ongoing comparisons of your chargemaster against the CMS rules, pricing methodology, Core Based Statistical Area (CBSA) and based on zip code by geographical location (called Reasonable & Customary (R&C)). ECS will also help design an RBRVS pricing methodology for physicians and their compensation model if you want to get to that level. We are regularly updating your chargemaster to reflect services offered at your facility. It's critical to focus on the chargemaster just as you focus on the revenue cycle.