Every hospital has what's known as a charge master. A charge master is a listing of every single procedure that a hospital can provide to its patients. Hospitals have charge masters because it helps to make the process of charge capture and billing move smoother. Charge masters have more than procedures on them. Pharmaceuticals, supply charges, and even some room charges are on charge masters.
Every procedure is supposed to be pre-coded with certain information such as price, procedure code, and revenue codes. Some often have modifiers, which are more specific indicators to insurance companies of the type of procedure that was performed. Hospital pricing can be determined in multiple ways, but their main purpose is to try to capture the costs of the hospital for performing those procedures.
Errors in coding can prevent hospital claims from being paid, as some codes change on a yearly basis. It is always crucial for hospitals to keep up to date with their coding. Patients always have the right to contact the hospital to ask the price of services, and in some hospitals they will be referred to the departments for these answers. Unfortunately, in many facilities, the price of procedures isn't known by either the department or the billing department right off the top, so you might have to ask to speak to a supervisor or director, who should be able to get you this information.
As it pertains to physicians offices or clinics, they also have charge masters for the same purpose, but they will be much smaller than the charge master at a hospital. Most of the time you will see sheets with multiple descriptions and numerical codes on them; if they're five digits, either all numbers or a letter and then 4 numbers, those are procedure codes. You may also see diagnosis codes on these forms, which can range from 3 digits to six digits (which may include a period); they will not be on a charge master, but are crucial towards getting paid.
Some hospitals across the country are now putting their prices up on the internet in what's known as pricing transparency. This is relatively new, as the rules used to state that hospitals couldn't do this sort of thing. It's always a good thing, when you have a choice, to compare prices before going to have services performed, but it's not always an option if your physician doesn't have admitting privileges to that hospital. Always remember that, at nonprofit hospitals, you always have the option of asking for charity care.
If you would like more information on how a charge master review takes place, please read this article on Misperceptions and Expectations of the Charge Master/Revenue Review Process. You can also check out this article on Charge Master Services. And if you want even more, check out my YouTube channel, where there are videos on charge master, pricing, and other business subjects addressed by T. T. Mitchell Consulting, Inc.
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