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 chargemaster or charge description master (CDM) is a basically a financial tool or an electronic system that housed detailed description/information about services charged 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 service items, 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
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
Medical billers often communicate with physicians and other health care professionals to explain diagnoses or to attain further information by means of phones, email, fax, etc. The biller must know how to read a medical record and be familiar with CPT®, HCPCS Level II and ICD-9-CM codes.
Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare.
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
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
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.
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.
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.
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 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
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
Among them is its emphasis on productivity. Fee for service encourages the delivery of care and maximizing patient visits. As a payment mechanism, it is relatively flexible in that it can be used regardless of the size or organizational structure of a physician’s practice, the type of care provided such in clinic visit, surgery, therapy session, and the place of service such as physician’s office, nursing home, hospital, surgery center or the geographical location of care. Fee for service does support accountability for patient care, but it is often limited to the scope of the service a particular physician provides at any point in time. Although fee for service is easy to understand conceptually, it can be difficult to understand in practice. Patients may struggle to decipher the coding and nomenclature involved in billing, manage the numerous bills and explanations of benefits they might receive, and understand its application in inpatient settings, especially for lab, radiology, and anesthesia services. Because payment is limited to one provider for one interaction, fee for service does little to encourage management of care across settings and among multiple
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,