Revenue Codes vs CPT/HCPCS Edits: Does Your Chargemaster Reflect Best Matches? + Chargemaster: A Critical Tool For Revenue Cycle Management – Combo

Revenue Codes vs CPT/HCPCS Edits: Does Your Chargemaster Reflect Best Matches?

A hospital chargemaster is a comprehensive list of a hospital’s products, procedures, and services. Everything from prescription drugs to supplies for diagnostic tests has a unique price listing in the chargemaster. Major components include revenue codes that reflect the site of service and applicable CPT/HCPCS codes that indicate the service provided/charged.

Poor matches between these code sets may lead to distorted cost centers, lost revenue, charges bundled that should be separately reported and incomplete departmental charging.

Webinar’s Goals

• Understand chargemaster code functions
• Understand revenue leakage resulting from poor chargemaster structure
• Understand why correct departmental charging is vital to revenue integrity
• Appropriate training for charge entry staff
• Billing attention to posted charges

Who Should Attend

• Chargemaster Maintenance Staff
• Compliance staff
• Billers
• Coders
• Revenue Cycle Managers & Staff
• Risk Management
• Charge entry staff

Chargemaster: A Critical Tool For Revenue Cycle Management

A hospital chargemaster is a comprehensive list of a hospital’s products, procedures, and services. Everything from prescription drugs to supplies for diagnostic tests has a unique price listing in the chargemaster and is used by hospital administrators, clinical documentation improvement specialists, and revenue directors.

Chargemasters include the following information

• The charge for a single unit of service
• A currect CPT code as described by the American Medical Association
• HCPCS II codes as applicable
• Alternate CPT & HCPCS codes that may be required by a specific payor
• A revenue code associated with the charge (Cost center that receives the revenue)
• Flags that indicate active, inactive charges or charges scheduled for deletion
• An internal general ledger number

Chargemaster rates serve as baselines when negotiating rates with payors but do not necessarily indicate the true costs of providing services. They should be updated at least annually, when new services are established, when current services are being discontinued and when percentage rates are increased.

Inadequate chargemaster management leads to revenue leakage in the following areas

• Multiple departments entering charges
• Chargemaster may be incorrect or incomplete
• Error in number of units selected
• Error in item selection
• Inactive charge
• New service not added
• Incorrect revenue code/cost center
• System conversions
• Overreliance on claims scrubber

Webinar’s Goals

• Understand chargemaster functions
• Understand revenue leakage resulting from poor chargemaster functions
• Understand why correct departmental charging is vital to revenue integrity
• Appropriate training for charge entry staff
• Billing attention to posted charges
• Accurate charges enhance patient satisfaction

Target Audience

• Chargemaster Maintenance Staff
• Physicians
• Practice managers
• Medical assistants
• Nurses
• Compliance staff
• Billers
• Coders
• Revenue Cycle
• Risk Management
• Charge entry staff