What is a Chargemaster? The chargemaster or charge description master (CDM) is a basically a financial tool or an electronic system that housed detailed description/information about service charges to patients. The chargemaster can be a manual list or a file that is located in the organization’s account receivable billing system that contains hospital’s services, item, and their charges. Furthermore, the chargemaster is a very crucial aspect of the reimbursement cycle and must contain vital information necessary to produce an itemized statement and claim form. Key components of the chargemaster include, chargemaster line-item numbers, line-item descriptions, revenue codes, CPT codes or healthcare common procedure coding system (HCPCS) codes, …show more content…
The duty to maintain the chargemaster should not solely be the responsibility of an individual. Rather, the duty to maintain the chargemaster should be of composed of committee that is a representative of all the organization’s departments that includes the HIM department, business office, information system, corporate compliance and department from hospital service areas such as the radiology, laboratory service, emergency department, respiratory therapist, cardiac catheterization laboratory, physical therapy, and nursing department (Bielby et al, 1999). Each department/service area in the hospital should be charged with the ownership and responsibility for completion of the chargemaster, and with the chargemaster committee serving as information resources for the organizations. Thus, it is imperative that the chargemaster committee engage each departments and service areas in order to develop an effective approach to managing the Chargemaster related issues. Duty of a Chargemaster …show more content…
The review on chargemaster must be perform at regular interval to enforce changes in the chargemaster in areas where there is pricing deficiencies (Benac, n.d.). The Case for Chargemaster Automation In recent times, healthcare organization across the nation are facing unprecedented challenges as they strive to improve the overall quality of care provided to their patient’s population, while improving their organization’s financial performance. Furthermore, uncertainty of new reimbursement models, diminishing reimbursement, and complicated compliance regulations are playing the role of a catalyst for streamlining the Chargemaster process in majority of healthcare organizations. Chargemaster Relationship to the Revenue Cycle The chargemaster is an integral element of the revenue cycle. It is used in generating charges for services that are rendered to patients in real time, the absence of functioning chargemaster can result in potential collapse of the revenue cycle. Hence, the process to optimize revenue cycle must include optimizing the chargemaster and all services that is associated with it. The negative consequences of nonfunctioning chargemaster can include excessive payment/overcharging, inaccurate billing to patients; and can result in stiff penalties and fines (Bielby et al,
The Hospitals medical staff including on call- physician and their designees should be made aware of Hospital bylaws or policies and procedures.
The first step to enforcing an appropriate chargemaster and to avoid all ramification associated with the status quo is to establish a position for chargemaster coordinator, and to create a chargemaster master department to facilitate the effective handing of our organization chargemaster. In addition to establishing chargemaster position and department, a chargemaster committee should be created that consist of all major departmental leadership. The duties of the chargemaster committee will involve developing a standardized form for handling charge related issues, and establishing a communication platform that will enable all departments to collaborate on chargemaster related issues. Furthermore, the chargemaster committee will also be responsible for creating a policies and procedures manual that will be used to reference information about the issue concerning
Abbey, D. C. (2010). Healthcare payment systems: Fee schedule payment systems. CRC Press. Retrieved from http://books.google.com/books?id=1uxIcqBAu_EC&dq=fee schedule payment system&source=gbs_navlinks_s
The twenty-first century has become a very market-driven place and health care is at its highest in demand for adjustment. In exertion to assist with this modification, the case study by Hill Physicians demonstrates an effective innovation pay-for- performance-incentive model for improved quality in health maintenance. In this subject field, Hill Physicians proves that engaging health information technology, innovative care management methods, predictive modelling, and financial incentives will provide higher quality and more efficient care. In this article, however, I will concentrate on two specific ethical issues connected to financial compensation and fairness in health maintenance. To achieve this aim, I will first discuss
In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. This drives up costs by rewarding providers for doing more, even when it’s not needed. ACOs continue to utilize fee for service by creating incentives to be more efficient by offering bonuses when providers keep ...
Module two deals with external influences in healthcare administration and the conflicts that may cause lack of growth in the organization. External influences can range from society, stakeholders, staff, and patients. Health administrators should be in agreement with staff and physicians to maintain proper ethics and safety for everyone. Society has a big influence of healthcare organizations with spending their money towards health insurance, medication, treatment services and exams. As long the healthcare organization has a well reputation built on trust, then consumers will spend on that healthcare organization. The stakeholders that take part in external influences on ethics are the vendors, technology specialists, maintenance, insurance
Since the quality of healthcare would not suffer, the only thing to lose through maximizing efficiency is a bunch of waste. Through its administrative simplification advocacy, the American Medical Association (AMA) claims that up to 14% of a physician’s revenue is taken up by administrative waste. The goal of the administrative simplification is to inspire physician practices to use computerized, instantaneous health plan transactions, minimize manual procedures through the claims revenue cycle, while increasing transparency and reducing vagueness with the payment process involving the insurance company. It is the AMA’s hope to push this movement into high gear, getting more practices on board and to eventually see a decline in wasteful and inefficient administrative
The Charge Description Master (CDM) commonly known as the chargemaster, is the computerized system used by hospitals to inventory and record services and items provided in various locations in the hospital. The chargemaster is automated and linked with the billing system.
This article takes a look at ten physician compensation models including the incentive structure and how they affect quality of care. The article compares these different models from three perspectives: a brief description, the underlying incentive structure, and the usage-related risks. The author states that a compensation model may comprise of multiple models given that healthcare organization may have more than one contract with its payers. While the author provided a complete comparison of each model, he did not state the preferred model for the healthcare industry. He concludes that most physicians and other health care leaders lack control of reimbursement for services from the federal and state government as well as private commercial
In the hospital setting, accountability issues can occur from a variety of issues such as not following orders, to medication errors, and not overseeing delegation of tasks. In every workplace there will be employees being held accountable for their lack of maintaining interpersonal boundaries. These issues can include discrimination, inappropriate sexual advances, and personal conversation that are not work appropriate.
The high flow rate of the Emergency Room causes the hospital staff to make clerical error in charting in CHS, costing the hospital lost revenue from uncharted captures of Class VIII and medications during procedures. Point-of-use cabinets are a solution that helps hospitals and its staff to increase charge captures and reduce nursing administrative time on CHS. The point-of-use cabinets require the user to input the patient’s name and identity to acquire mediation or Class VIII. According to Omnicell (N.D.) This point-of-use system can result in “45% increase in charge capture” of lost revenue from possible oversight when the charting is done after the patient being
Fee-for-service is a retrospective reimbursement system in which providers create a comprehensive list of services they provided to a patient and the materials, supplies, and facilities they used to provide those services and then bill the patient’s insurer (or the patient, if he/she is self-pay) for each item on the list (Cellucci et al., 2014). Traditionally physicians were reimbursed on a fee for service basis. In a fee for service arrangement, physicians were paid based on the numbers of services administered to the patients. Fee for service gave providers an incentive to provided more treatment because payment was dependent on the quantity of care rather than the quality of care. Some of the disadvantages of
This changed in the mid – 1980’s when Medicare substituted a prospective payment system for the cost plus system to reimburse inpatient hospital services. This system was based on diagnosis-related groups that provide fixed case-based payments to hospitals. The Ambulatory sector was unlimited therefore hospitals began to shorten inpatient stays to provide Ambulatory treatment. In 2000, Medicare implemented a reimbursement for ambulance services called the Ambulatory Prospective Payment System for hospital ambulance departments and home health resource groups. This to health with cost containment and stress, lower inpatient use.
The diagnoses associated with the hospital stay are placed into groups requiring a similar intensity of services. The DRG reimbursement, similar to the system used by the federal Medicare program, is based on the average cost of providing services for the specific diagnosis group, regardless of how long a specific client may have actually been in the hospital. The department does adjust payments for exceptionally long stays or exceptionally high costs. It also pays hospitals for the capital costs associated with the Medicaid inpatient
There are concentrated efforts being undertaken by the healthcare industry to reduce cost and improve quality, for instance: hospitals have implemented policies and process to reduce nosocomial infections, this can in turn reduce the cost and increase the quality of care. Another example where cost can be controlled is by reducing the rate of readmissions, which could be preventable by adequate discharge follow-up in the form of telephone calls, and reminders for outpatient appointments. Another ideal which is in discussion is single payment for care, which means paying a single rate for the whole episode of care. One of the inadvertent consequence ("CHQPR," 2011). Moving to electronic records was an initiative undertaking by the Obama administration improve quality and reduce cost, but this move has motivated some providers to bill more for their services (Eyermann,