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Chargemaster

March 16, 2024

For the British electric vehicle charging infrastructure company, see Chargemaster (company).

In the United States, the chargemaster, also known as charge master, or charge description master (CDM), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital.[1][2][3] The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital. It is described as "the central mechanism of the revenue cycle" of a hospital.

Description edit

The chargemaster may be alternatively referred to as the "charge master", "hospital chargemaster", or the "charge description master" (CDM).[4][5] It is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider.[3][6] It is described as "the central mechanism of the revenue cycle" of a hospital.[7] Chargemasters include thousands of hospital services, medical procedures, equipment fees, drugs, supplies, and diagnostic evaluations such as imaging and blood tests.[6] Each item in the chargemaster is assigned a unique identifier code and a set price that are used to generate patient bills.[6] Every hospital system maintains its own chargemaster.[6] Traditionally, hospitals regarded their chargemaster, alongside the medical codes that catalogue the billing items, as a trade secret that is central to their business, and state laws and courts have historically accepted the view that these are proprietary information.[8][9]

The procedure of developing, maintaining, and monitoring the chargemaster and its pricing scheme often necessitates multiple hospital employees working under the supervision of a "chargemaster coordinator",[10][11] a "charge master manager", or others in the health care system's operations or administrative support areas frequently called a "charge master team".[citation needed] Ultimate responsibility for ensuring accuracy of the chargemaster rests with each hospital's chief financial officer,[12] compliance officer, and hospital Board.[citation needed] Approximately forty percent of hospitals pay outside companies to help create and then adapt their chargemasters on a yearly basis.[11] According to Essentials of Managed Health Care, as of 2012 the chargemaster file typically included between 20,000 and 50,000 price definitions.[13][14] The Lewin Group analyzed utilization of the chargemaster and found that a low proportion of hospitals carried out regular reviews of their chargemaster implementation.[15] Costs for patients maintained on the chargemaster differ greatly from hospital to hospital.[16]

Authors J. Patrick Rooney and Dan Perrin note in their book America's Health Care Crisis Solved, "Charge-master rates, in reality, serve as nothing more than the starting point for negotiations" with the payer.[17] The impact of the chargemaster is such that those with good insurance or better access to means to afford quality healthcare pay the least for that care, whereas conversely uninsured, and others who pay out-of-pocket for healthcare pay the full chargemaster listed price for the same services.[18][19]

Existing legislation and regulations edit

Federally all hospitals are now required to post their chargemaster on the hospital website.[20]

Hospital price transparency helps Americans know the cost of a hospital item or service before receiving it. Starting January 1, 2021, each hospital operating in the United States will be required to provide clear, accessible pricing information online about the items and services they provide in two ways.[citation needed]

In California, a regulation known as the "Payers' Bill of Rights" (which is unique to the state) requires all hospitals to provide their chargemaster to the state, which then posts them online for the public.[6][21]

The chargemaster procedure is generally only regulated in Maryland; author Peter Reid Kongstvedt notes in Essentials of Managed Care, "Of particular importance, other than in Maryland, hospitals are generally free to charge whatever they want in their chargemaster."[14]

Critical analysis edit

Chargemasters gained national attention in early 2013, when in short succession, there were two important publications made. First, there was a Time magazine cover story published February 20, 2013, titled "Bitter Pill: Why Medical Bills Are Killing Us",[3] in which reporter Steven Brill examined the overlooked role that chargemasters played in the American health care system's cost crisis, asserting that they routinely listed extremely high prices "devoid of any calculation related to cost", and were generally regarded as "fiction" in the healthcare industry, despite their significant role in setting prices for both insured and uninsured patients alike.[3] Then, a couple months later, the Centers for Medicare and Medicaid Services published inpatient prices for hospitals across the country in a publicly available format.[22]

"The 'full charges' reflected on hospital Charge Masters are unconscionable", wrote George A. Nation III in a 2005 piece for the Kentucky Law Journal.[23] Health care economist scholar Uwe Reinhardt noted in a 2006 article for Health Affairs that the approach to chargemasters by hospitals would have to be modified to become more transparent, in order to encourage a form of consumer-driven health care to help improve the system.[24] University of California, Berkeley professor of health economics James C. Robinson pointed out prior criticism of the chargemaster, "Much ink has been spilt bemoaning that incomprehensible foundation of hospital cost accounting and prices, the redoubtable chargemaster."[25] Robinson called for greater transparency as well as increased price standardization as steps to help remedy the situation.[25]

In a 2007 article for Health Affairs, Gerard F. Anderson observed, "Without knowing what services they will use in advance, it is impossible for patients to comparison shop."[26] Anderson also noted the esoteric nature of the language on the chargemaster made it difficult for patients and anyone other than hospital administrators to understand.[26] Anderson emphasized the difficulty of patients' ability to interpret the chargemaster in a subsequent 2012 article: "Furthermore, most of the items on the charge master file are written in code so that only the hospital administrators and a few experts in the field can interpret their meanings."[27]

See also edit

References edit

  1. ^ Rosenberg, Tina (July 31, 2013). "Revealing a Health Care Secret: The Price". The New York Times. Retrieved August 1, 2013.
  2. ^ Rosenthal, Elisabeth (June 2, 2013). "The $2.7 Trillion Medical Bill – Colonoscopies Explain Why U.S. Leads the World in Health Expenditures". The New York Times. Retrieved August 1, 2013.
  3. ^ a b c d Brill, Steven (February 20, 2013). "Bitter Pill: Why Medical Bills Are Killing Us". Time. Time Warner. Archived from the original on February 26, 2013. Retrieved March 4, 2013.
  4. ^ Peden, Ann (2011). Comparative Health Information Management. Delmar Cengage Learning. pp. 41–43. ISBN 978-1111125622.
  5. ^ Tyson-Howard, Carla; Shirlyn C. Thomas (2009). The Comprehensive Review Guide for Health Information: RHIA & RHIT Exam Prep. Jones and Bartlett Publishers, LLC. pp. 49–51. ISBN 978-0-7637-5661-1.
  6. ^ a b c d e State of California Office of Statewide Health Planning and Development (August 8, 2012). "Healthcare Information Division: Annual Financial Data – General Information About the Hospital Chargemaster Program". OSHPD – HID. State of California. Retrieved March 4, 2013.
  7. ^ Herman, Bob (October 3, 2012). "5 Things Hospitals Should Know About Their Chargemaster and ICD-10". Becker's Hospital Review. ASC Communications. Retrieved March 4, 2013.
  8. ^ Rosenthal, Elisabeth (2017-03-29). "Those Indecipherable Medical Bills? They're One Reason Health Care Costs So Much". The New York Times. ISSN 0362-4331. Retrieved 2017-04-03.
  9. ^ "Hospital Price Transparency". Centers for Medicare and Medicaid services. Retrieved 21 May 2022.
  10. ^ Abbey, Duane C. (2005). Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance. Opus Communications. pp. 2–4. ISBN 1578396301.
  11. ^ a b Davis, T. Neil (2008). Mired in the Health Care Morass. Ester Republic Press. pp. 54–55. ISBN 978-0974922140.
  12. ^ Schneider, Carl E. (July 2007). "The Cash Nexus". Hastings Center Report. Project MUSE. 37 (4): 11–12. doi:10.1353/hcr.2007.0061. PMID 17844914. S2CID 9278168.
  13. ^ Kongstvedt, Peter. "Errata Sheet for The Essentials of Managed Health Care, Sixth Edition, Jones & Bartlett" (PDF).
  14. ^ a b Kongstvedt, Peter Reid (2012). Essentials of Managed Health Care. Jones & Bartlett Learning. pp. 114–115. ISBN 978-1449604646.
  15. ^ Bartlette, Linda A.; Ida F. Lawso (2008). Health Care Policies. Nova Science Pub Inc. pp. 11–13. ISBN 978-1604563528.
  16. ^ Hammaker, Donna K.; Sarah J. Tomlinson (2010). Health Care Management and the Law: Principles and Applications. Delmar Cengage Learning. pp. 152–154. ISBN 978-1428320048.
  17. ^ Rooney, J. Patrick; Perrin, Dan (2008). America's Health Care Crisis Solved: Money-Saving Solutions, Coverage for Everyone. Wiley. pp. 137–139. ISBN 978-0470275726.
  18. ^ Henderson, James W. (2008). Health Economics & Policy. South-Western College Pub. pp. 269–271. ISBN 978-0324645187.
  19. ^ Kongstvedt, Peter (2009). Managed Care: What It Is and How It Works. Jones & Bartlett Publishers. p. 212. ISBN 978-0763759117.
  20. ^ "Hospital Price Transparency | CMS".
  21. ^ Herman, Bob (July 16, 2012). "Report: Surgery Prices Vary Wildly at California Hospitals". Becker's Hospital Review. ASC Communications. Retrieved March 4, 2013.
  22. ^ Young, Jeffrey; Kirkham, Chris (2013-05-08). "Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences". Huffington Post. Retrieved 2013-06-24.
  23. ^ Nation III, George A. (2005). "Obscene Contracts: The Doctrine of Unconscionability and Hospital Billing of the Uninsured". Kentucky Law Journal. University of Kentucky College of Law. 94: 101.
  24. ^ Reinhardt, Uwe (January 2006). "The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy". Health Affairs. 25 (1): 57–69. doi:10.1377/hlthaff.25.1.57. PMID 16403745.
  25. ^ a b Robinson, James C. (2007). (PDF). Frontiers of Health Services Management. American College of Healthcare Executives. 23 (3): 25–28. doi:10.1097/01974520-200701000-00004. PMID 17405389. S2CID 14263360. Archived from the original (PDF) on 2013-05-21. Retrieved 2013-03-05.
  26. ^ a b Anderson, Gerard F. (May 2007). "From 'Soak The Rich' To 'Soak The Poor': Recent Trends In Hospital Pricing". Health Affairs. Project HOPE: The People-to-People Health Foundation, Inc. 26 (3): 780–789. doi:10.1377/hlthaff.26.3.780. PMID 17485757.
  27. ^ Anderson, Gerard; Chalkidou, Kalipso; Herring, Bradley (September 2012). "High US Health-Care Spending and the Importance of Provider Payment Rates". Forum for Health Economics & Policy. 15 (3): 1–22. doi:10.1515/fhep-2012-0007. ISSN 1558-9544. PMID 31419860. S2CID 154853606.

Further reading edit

  • Brill, Steven (February 20, 2013). "Bitter Pill: Why Medical Bills Are Killing Us". Time. Time Warner. Archived from the original on February 26, 2013. Retrieved March 7, 2013.
  • Brill, Steven (March 5, 2013). . "Stories I'd like to see" blog. Thomson Reuters. Archived from the original on March 7, 2013. Retrieved March 25, 2013. Alternate link, Columbia Journalism Review.

External links edit

 
Wikiquote has quotations related to Chargemaster.
 
Look up chargemaster in Wiktionary, the free dictionary.
  • Database of hospital chargemasters in California, Office of Statewide Health Planning and Development, State of California
  • Medicare Provider Charge Data, Centers for Medicare & Medicaid Services

March 16, 2024
chargemaster, british, electric, vehicle, charging, infrastructure, company, company, united, states, chargemaster, also, known, charge, master, charge, description, master, comprehensive, listing, items, billable, hospital, patient, patient, health, insurance. For the British electric vehicle charging infrastructure company see Chargemaster company In the United States the chargemaster also known as charge master or charge description master CDM is a comprehensive listing of items billable to a hospital patient or a patient s health insurance provider In practice it usually contains highly inflated prices at several times that of actual costs to the hospital 1 2 3 The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital It is described as the central mechanism of the revenue cycle of a hospital Contents 1 Description 2 Existing legislation and regulations 3 Critical analysis 4 See also 5 References 6 Further reading 7 External linksDescription editThe chargemaster may be alternatively referred to as the charge master hospital chargemaster or the charge description master CDM 4 5 It is a comprehensive listing of items billable to a hospital patient or a patient s health insurance provider 3 6 It is described as the central mechanism of the revenue cycle of a hospital 7 Chargemasters include thousands of hospital services medical procedures equipment fees drugs supplies and diagnostic evaluations such as imaging and blood tests 6 Each item in the chargemaster is assigned a unique identifier code and a set price that are used to generate patient bills 6 Every hospital system maintains its own chargemaster 6 Traditionally hospitals regarded their chargemaster alongside the medical codes that catalogue the billing items as a trade secret that is central to their business and state laws and courts have historically accepted the view that these are proprietary information 8 9 The procedure of developing maintaining and monitoring the chargemaster and its pricing scheme often necessitates multiple hospital employees working under the supervision of a chargemaster coordinator 10 11 a charge master manager or others in the health care system s operations or administrative support areas frequently called a charge master team citation needed Ultimate responsibility for ensuring accuracy of the chargemaster rests with each hospital s chief financial officer 12 compliance officer and hospital Board citation needed Approximately forty percent of hospitals pay outside companies to help create and then adapt their chargemasters on a yearly basis 11 According to Essentials of Managed Health Care as of 2012 the chargemaster file typically included between 20 000 and 50 000 price definitions 13 14 The Lewin Group analyzed utilization of the chargemaster and found that a low proportion of hospitals carried out regular reviews of their chargemaster implementation 15 Costs for patients maintained on the chargemaster differ greatly from hospital to hospital 16 Authors J Patrick Rooney and Dan Perrin note in their book America s Health Care Crisis Solved Charge master rates in reality serve as nothing more than the starting point for negotiations with the payer 17 The impact of the chargemaster is such that those with good insurance or better access to means to afford quality healthcare pay the least for that care whereas conversely uninsured and others who pay out of pocket for healthcare pay the full chargemaster listed price for the same services 18 19 Existing legislation and regulations editFederally all hospitals are now required to post their chargemaster on the hospital website 20 Hospital price transparency helps Americans know the cost of a hospital item or service before receiving it Starting January 1 2021 each hospital operating in the United States will be required to provide clear accessible pricing information online about the items and services they provide in two ways citation needed In California a regulation known as the Payers Bill of Rights which is unique to the state requires all hospitals to provide their chargemaster to the state which then posts them online for the public 6 21 The chargemaster procedure is generally only regulated in Maryland author Peter Reid Kongstvedt notes in Essentials of Managed Care Of particular importance other than in Maryland hospitals are generally free to charge whatever they want in their chargemaster 14 Critical analysis editChargemasters gained national attention in early 2013 when in short succession there were two important publications made First there was a Time magazine cover story published February 20 2013 titled Bitter Pill Why Medical Bills Are Killing Us 3 in which reporter Steven Brill examined the overlooked role that chargemasters played in the American health care system s cost crisis asserting that they routinely listed extremely high prices devoid of any calculation related to cost and were generally regarded as fiction in the healthcare industry despite their significant role in setting prices for both insured and uninsured patients alike 3 Then a couple months later the Centers for Medicare and Medicaid Services published inpatient prices for hospitals across the country in a publicly available format 22 The full charges reflected on hospital Charge Masters are unconscionable wrote George A Nation III in a 2005 piece for the Kentucky Law Journal 23 Health care economist scholar Uwe Reinhardt noted in a 2006 article for Health Affairs that the approach to chargemasters by hospitals would have to be modified to become more transparent in order to encourage a form of consumer driven health care to help improve the system 24 University of California Berkeley professor of health economics James C Robinson pointed out prior criticism of the chargemaster Much ink has been spilt bemoaning that incomprehensible foundation of hospital cost accounting and prices the redoubtable chargemaster 25 Robinson called for greater transparency as well as increased price standardization as steps to help remedy the situation 25 In a 2007 article for Health Affairs Gerard F Anderson observed Without knowing what services they will use in advance it is impossible for patients to comparison shop 26 Anderson also noted the esoteric nature of the language on the chargemaster made it difficult for patients and anyone other than hospital administrators to understand 26 Anderson emphasized the difficulty of patients ability to interpret the chargemaster in a subsequent 2012 article Furthermore most of the items on the charge master file are written in code so that only the hospital administrators and a few experts in the field can interpret their meanings 27 See also edit nbsp Economics portal nbsp Medicine portal nbsp United States portalCharity care Dartmouth Atlas of Health Care Explanation of benefits insurance Healthcare Blue Book Health care prices Health insurance in the United States Health insurance costs in the United States J Patrick Rooney Medical debt UnderinsuredReferences edit Rosenberg Tina July 31 2013 Revealing a Health Care Secret The Price The New York Times Retrieved August 1 2013 Rosenthal Elisabeth June 2 2013 The 2 7 Trillion Medical Bill Colonoscopies Explain Why U S Leads the World in Health Expenditures The New York Times Retrieved August 1 2013 a b c d Brill Steven February 20 2013 Bitter Pill Why Medical Bills Are Killing Us Time Time Warner Archived from the original on February 26 2013 Retrieved March 4 2013 Peden Ann 2011 Comparative Health Information Management Delmar Cengage Learning pp 41 43 ISBN 978 1111125622 Tyson Howard Carla Shirlyn C Thomas 2009 The Comprehensive Review Guide for Health Information RHIA amp RHIT Exam Prep Jones and Bartlett Publishers LLC pp 49 51 ISBN 978 0 7637 5661 1 a b c d e State of California Office of Statewide Health Planning and Development August 8 2012 Healthcare Information Division Annual Financial Data General Information About the Hospital Chargemaster Program OSHPD HID State of California Retrieved March 4 2013 Herman Bob October 3 2012 5 Things Hospitals Should Know About Their Chargemaster and ICD 10 Becker s Hospital Review ASC Communications Retrieved March 4 2013 Rosenthal Elisabeth 2017 03 29 Those Indecipherable Medical Bills They re One Reason Health Care Costs So Much The New York Times ISSN 0362 4331 Retrieved 2017 04 03 Hospital Price Transparency Centers for Medicare and Medicaid services Retrieved 21 May 2022 Abbey Duane C 2005 Chargemasters Strategies to Ensure Accurate Reimbursement and Compliance Opus Communications pp 2 4 ISBN 1578396301 a b Davis T Neil 2008 Mired in the Health Care Morass Ester Republic Press pp 54 55 ISBN 978 0974922140 Schneider Carl E July 2007 The Cash Nexus Hastings Center Report Project MUSE 37 4 11 12 doi 10 1353 hcr 2007 0061 PMID 17844914 S2CID 9278168 Kongstvedt Peter Errata Sheet for The Essentials of Managed Health Care Sixth Edition Jones amp Bartlett PDF a b Kongstvedt Peter Reid 2012 Essentials of Managed Health Care Jones amp Bartlett Learning pp 114 115 ISBN 978 1449604646 Bartlette Linda A Ida F Lawso 2008 Health Care Policies Nova Science Pub Inc pp 11 13 ISBN 978 1604563528 Hammaker Donna K Sarah J Tomlinson 2010 Health Care Management and the Law Principles and Applications Delmar Cengage Learning pp 152 154 ISBN 978 1428320048 Rooney J Patrick Perrin Dan 2008 America s Health Care Crisis Solved Money Saving Solutions Coverage for Everyone Wiley pp 137 139 ISBN 978 0470275726 Henderson James W 2008 Health Economics amp Policy South Western College Pub pp 269 271 ISBN 978 0324645187 Kongstvedt Peter 2009 Managed Care What It Is and How It Works Jones amp Bartlett Publishers p 212 ISBN 978 0763759117 Hospital Price Transparency CMS Herman Bob July 16 2012 Report Surgery Prices Vary Wildly at California Hospitals Becker s Hospital Review ASC Communications Retrieved March 4 2013 Young Jeffrey Kirkham Chris 2013 05 08 Hospital Prices No Longer Secret As New Data Reveals Bewildering System Staggering Cost Differences Huffington Post Retrieved 2013 06 24 Nation III George A 2005 Obscene Contracts The Doctrine of Unconscionability and Hospital Billing of the Uninsured Kentucky Law Journal University of Kentucky College of Law 94 101 Reinhardt Uwe January 2006 The Pricing Of U S Hospital Services Chaos Behind A Veil Of Secrecy Health Affairs 25 1 57 69 doi 10 1377 hlthaff 25 1 57 PMID 16403745 a b Robinson James C 2007 Price Transparency Begins at Home PDF Frontiers of Health Services Management American College of Healthcare Executives 23 3 25 28 doi 10 1097 01974520 200701000 00004 PMID 17405389 S2CID 14263360 Archived from the original PDF on 2013 05 21 Retrieved 2013 03 05 a b Anderson Gerard F May 2007 From Soak The Rich To Soak The Poor Recent Trends In Hospital Pricing Health Affairs Project HOPE The People to People Health Foundation Inc 26 3 780 789 doi 10 1377 hlthaff 26 3 780 PMID 17485757 Anderson Gerard Chalkidou Kalipso Herring Bradley September 2012 High US Health Care Spending and the Importance of Provider Payment Rates Forum for Health Economics amp Policy 15 3 1 22 doi 10 1515 fhep 2012 0007 ISSN 1558 9544 PMID 31419860 S2CID 154853606 Further reading editBrill Steven February 20 2013 Bitter Pill Why Medical Bills Are Killing Us Time Time Warner Archived from the original on February 26 2013 Retrieved March 7 2013 Brill Steven March 5 2013 Coming up with A Bitter Pill Stories I d like to see blog Thomson Reuters Archived from the original on March 7 2013 Retrieved March 25 2013 Alternate link Columbia Journalism Review External links edit nbsp Wikiquote has quotations related to Chargemaster nbsp Look up chargemaster in Wiktionary the free dictionary Database of hospital chargemasters in California Office of Statewide Health Planning and Development State of California Medicare Provider Charge Data Centers for Medicare amp Medicaid Services Retrieved from https en wikipedia org w index php title Chargemaster amp oldid 1186809910, wikipedia, wiki, book, books, library,

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